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The most important serious side effects include acute pancreatitis (severe persistent abdominal pain radiating to the back, though clinical trials found similar pancreatitis rates to comparators), severe dehydration from persistent vomiting or diarrhea (signs include dizziness, decreased urination, extreme thirst), gallbladder disease including cholecystitis or cholelithiasis (right upper quadrant pain, fever, jaundice), severe allergic reactions (difficulty breathing, swelling of face or throat), and severe hypoglycemia when combined with insulin or sulfonylureas (confusion, loss of consciousness, seizures)

Proceedings of the American Academy of Arts and Sciences

Once B12 levels improve and you are no longer deficient, your treatment may be switched to supplements

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