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The most frequent adverse reactions associated with vitamin B12 are transient chromaturia, increased blood pressure, nausea, and headache

The FDA prescribing information explicitly warns against taking vitamin A supplements alongside isotretinoin because of the risk of additive hypervitaminosis A toxicity, which can produce symptoms including pseudotumor cerebri (raised intracranial pressure), hepatotoxicity, and bone changes [1]

Additionally, lactic acid reduced the expression of key effector molecules and altered immune cell metabolism, further dampening anti-tumor responses (138)