Having said that some patients do get a paradoxical response to B12 and present with fatigue, headaches, and flu-like symptoms
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The free PSA is a defective variant of normal PSA that can no longer bind to other proteins and so circulates in the blood in the free form
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Red or purple chromaturia is a side effect of hydroxocobalamin, typically resolving over several weeks.2 Additional causes of red urine include blood (e.g., traumatic catheterization, malignancy, infection), dietary ingestion (e.g., beets), and medications (e.g., rifampin, phenothiazines).3 Although benign and not warranting further evaluation by itself, hydroxocobalamin-induced discolouration of body fluids may interfere with colorimetric sensors
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