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Common side effects include: Injection site reactions mild pain, redness, swelling, or bruising at the injection site, typically resolving within a few days Headache usually transient and manageable with standard analgesia Nausea or dizziness particularly in the initial treatment phase Skin reactions including itching, mild rash, or acneiform eruptions Temporary urine discolouration red or orange urine is harmless and expected Diarrhoea or flushing usually mild and self-limiting In patients with severe megaloblastic anaemia, low potassium levels (hypokalaemia) may occur during initial intensive treatment, but this is uncommon in routine maintenance therapy

In addition, the administration of MTZ decreased the raised levels of NO and MDA, enhanced the activity of glutathione peroxidase (GPx) and SOD, and decreased the activity of MPO (Khedr 2015)

(ii) Supports pain management: NAD+ is the best therapy and is the best and popular way to manage pain

Inhibition of either mitogen-activated protein kinase (MAPK)/ extracellular signal-regulated kinase (ERK) or phosphatidylinositol 3-kinase (PI3K)/protein kinase B (PKB/AKT) signaling pathway attenuated this effect