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In a 2022 animal study examining infected diabetic wounds, doses up to 5 mg/kg showed no hepatotoxicity or renal impairment.(pubmed.ncbi.nlm.nih.gov) Copper overload risk: Chronic high doses could, in theory, raise serum copper and lower zinc, leading to nausea or neurologic symptoms

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In animal studies, hydroxocobalamin administered to pregnant rats and rabbits during the period of organogenesis caused skeletal and soft tissue abnormalities, including alterations in the central nervous system, at exposures similar to human exposures at the therapeutic dose