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doi:10.1016/S0736-0266(03)00110-4 Goldstein AL, Hannappel E, Sosne G, Kleinman HK

Cautious use of parenteral cyanocobalamin is also recommended in patients with renal impairment, including premature neonates, because of the possibility of greater aluminum accumulation, which may cause central nervous system and bone toxicity

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Experimental models have examined its influence on vascular endothelial growth factor receptor-2 (VEGFR2) signaling, including activation of downstream VEGFR2AkteNOS pathways associated with endothelial cell proliferation and vascular signaling processes