this occurs because there is not enough vitamin B12 in the diet or poor absorption Pernicious anemiaa type of megaloblastic anemia caused by a lack of intrinsic factor so that vitamin B12 is not absorbed Fatigue, weakness Nerve damage with numbness, tingling in the hands and legs Memory loss, confusion Dementia Depression Seizures Toxicity Toxicity Vitamin B12 is a water-soluble vitamin, so any unused amount will exit the body through the urine
She was treated with 10 days of prednisone and valaciclovir unsuccessfully

You should not take cyanocobalamin-based products if you: Have a known cobalt allergy Have Lebers hereditary optic neuropathy , as B12 can worsen vision in this condition Discuss nasal B12 with your clinician first if you have: Severe megaloblastic anemia Polycythemia vera or other bone marrow disorders Low iron or folate Kidney disease Are undergoing chemotherapy or using bone marrowsuppressing drugs Are pregnant or breastfeeding Possible Side Effects Most side effects reported with B12 nasal products are mild and temporary: Slight nasal irritation, burning, or dryness Runny or stuffy nose, sneezing, or sore throat Mild headache Nausea or a brief metallic taste Tingling or pins and needles sensations, especially early on as nerves recover Serious reactions are rare but require immediate medical care: Rash, hives, or intense itching Swelling of the face, lips, tongue, or throat Trouble breathing or swallowing Fever, chills, or signs of infection that dont match a simple cold If anything feels out of proportion or youre unsure, stop the product and speak with your healthcare provider or seek urgent care

Its important not to mix certain drugs and medications while taking prozac
Verhoef et al, 1997b