Carpal tunnel syndrome, edema, and arthralgias are the most common adverse effects at supraphysiologic doses
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These include deficiencies of vitamin B12, folate or niacin, and infective causes including cryptococcal meningitis, HIV, Lyme disease, progressive multifocal leukoencephalopathy, subacute sclerosing panencephalitis, syphilis and Whipple's disease
They also suggest that the elevation of homocysteine may have multifactorial effects, interacting with both the vascular wall structure and the blood coagulation system, with different outcomes depending on the tissue and on the consequent degree of hyperhomocysteinemia