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Vitamin B12 is generally considered safe, even at high doses, because it is water-soluble and excess amounts are excreted in urine

human clinical trials are limited

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If vitamin B12 deficiency due to recreational use of nitrous oxide is suspected, homocysteine or methylmalonic acid should be the initial test as nitrous oxide inactivates the vitamin B12 molecule, which can result in normal total and active B12 concentrations despite tissue deficiency