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GI symptoms like nausea or bloating are most pronounced in the first 72 hours after the initial injection and diminish progressively with each subsequent dose as homocysteine clearance pathways upregulate

Schneider, J

M., & Nassar, M

CACT is a reverse transport protein that uses electrochemical gradients to exchange acylcarnitine in the cytoplasm with free carnitine in the matrix, achieving net transport of acyl groups

B12 supports methylation reactions that convert homocysteine back to methionine

B., Vidal, Nicolas, Ali, Syed A., King, Glenn F., Vasudevan, Karthikeyan, Vasconcelos, Vitor and Antunes, Agostinho (2013)