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For example, in oral dosing trials for diabetic neuropathy, patients receiving 1200 mg to 1800 mg per day of ALA had a greater occurrence of nausea, vomiting, and vertigo compared to those receiving 600 mg per day

Br J Clin Pharmacol 71:2028 Shayiq RM, Roberts DW, Rothstein K, Snawder JE, Benson W, Ma X, Black M (1999) Repeat exposure to incremental doses of acetaminophen provides protection against acetaminophen-induced lethality in mice: an explanation for high acetaminophen dosage in humans without hepatic injury

Therefore, treatment with Nascobal (cyanocobalamin) Nasal Spray should be deferred until symptoms have subsided