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Joint discomfort associated with B12 supplementation is uncommon and not listed amongst the recognised adverse effects in the Summary of Product Characteristics (SmPC) for licensed B12 preparations or in the British National Formulary (BNF)

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Most common causes of the discolouration include: Medications amino-salicyclic acid derivatives mesalazine/paraaminosalycylic acid/sulfasalazine doxorubicin , hydroxocobalamin , ibuprofen, phenothiazines, phenolphthalein, propofol , rifampicin/rifampin Dietary ingestants beeturia , rhubarb, blackberries, food dyes Metabolic abnormalities porphyria , urate crystals Hydroxocobalamin Early features of cyanide poisoning include nausea, vomiting, headache, dyspnoea, tachypnoea, hypertension, tachycardia, collapse and seizures

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