Pyridoxine is a precursor compound that is converted to pyridoxal. Pyridoxal facilitates the metabolism of glucose, carbohydrates, and fats. Deficiency of pyridoxine may result in cheilosis, stomatitis, depression, anemia, and neurological deterioration.

It is applied to treat and prevent pyridoxine (vitamin B6) deficiency in individuals.

• Off Label Uses of Pyridoxine (vitamin B6) in Adults include:

  • Ethylene glycol poisoning

  • Overdose from a gyromitrin-containing bogus morel mushroom

  • Nausea and vomiting during pregnancy

  • For the treatment and prevention of isoniazid overdose-related neurological damage (seizures and coma).

  • For the purpose of preventing isoniazid-related neuropathy (for the treatment of Mycobacterium tuberculosis).

Vitamin B6 Dose in Adults

Dose in the treatment of Pyridoxine deficiency:

• For three weeks, administer 10–20 mg/day intramuscularly or intravenously. Then, for many weeks, administer daily oral treatment.
• Patients with pyridoxine dependency syndrome may need higher doses up to 600 mg/day

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Off-label use in the treatment of Ethylene glycol poisoning

• Every day until the intoxication has subsided, 100 mg intravenously (as an adjunct to the antidote)

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Dose as off-label use in the treatment and prophylaxis of Gyromitrin-containing fake morel mushroom overdose:

• 25 mg per kg intravenously over a 15- to 30-minute period.
• The dose may be repeated as needed to control seizures.

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Dose as off-label use in the treatment of Nausea and vomiting during pregnancy:

• It can be administered either alone or in conjunction with doxylamine.
• 10–25 mg taken orally three-four times a day.
• Depending on how severe the symptoms are, the dose may be changed.

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Dose as an off-label use to prevent neurological toxicities (coma and seizures) brought on by isoniazid overdose:

• The dosage guidelines for treating individuals who are symptomatic are the same as those for treating patients who are asymptomatic.
• A preventive dose of intravenous pyridoxine must be given to patients who are asymptomatic but arrive within two hours of taking a risky dose of isoniazid.

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Treatment of neurological toxicities (seizures and coma) brought on by isoniazid overdose with a dose as an off-label use:

• Acute ingestion of known amount:
  • The dosage should be given between 0.5 and 1 grammes per minute until the maximum dose has been reached or the seizures have stopped.
  • A maximum dose of 5 g of pyridoxine or a dose equivalent to the quantity of consumed isoniazid may be supplied.
  • If seizures end before the predicted dose is administered, the remaining dose may be injected over a 4- to 6-hour period.
  • It may be repeated as often as every five to ten minutes to manage ongoing seizure activity and CNS toxicity.
• Acute ingestion of unknown amount:
  • 5 grammes intravenously, given at a rate of 0.5–1 grammes per minute.
  • To treat persistent seizure activity and central nervous system toxicity, the dose may be administered again every 5 to 10 minutes as necessary.

Dosage for preventing peripheral neuropathy brought on by isoniazid therapy for Mycobacterium tuberculosis:

• 25 - 50 mg/day orally.

Vitamin B6 Dose in Children

Dose in the treatment of Pyridoxine deficiency: 

• Children:
  • 2.5-5 mg per day in a multivitamin product after 3 weeks of daily doses of 5 to 25 mg orally, intramuscularly, or intravenously.
• Adolescents:
  • For three weeks, take 10–20 mg/day orally, intramuscularly, or intravenously, followed by 2–5 mg/day.

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Dose in the treatment of Pyridoxine-dependent seizures:

• Infants and Children:
  • A 50–100 mg intravenous starting dosage is followed by a 50–100 mg daily maintenance dose.
  • Typically, the range is 10-200 mg.

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Use in patients with cycloserine, isoniazid, or penicillamine-induced deficiency or toxicity:

• For the prevention of Isoniazid and Cycloserine toxicity:

Recommendations: For patients who could be at risk.

• These include:
  • Individuals whose diets are deficient in meat and milk
  • Infants who are exclusively breastfed
  • Nutritional deficiency
  • Pregnant adolescents 

Non-HIV-exposed patients or HIV-positive patients:

Infants and Children:

• 1 mg/kg/day.
• The usual dose range s between 10 and 50 mg/day.
• Adolescents:
  • 30 mg/day

HIV-exposed or HIV-positive patients:

Infants and Children:

• 1 - 2 mg/kg once a day to a maximum daily dose of 50 mg/day.

Adolescents:

• 25 mg/day.

Treatment of isoniazid and cycloserine toxicity:

Infants and Children:

• The optimal dose of pyridoxine is not established, however, higher doses in the ranges of 100 mg to 200 mg/day may be necessary for symptomatic patients as in patients with neuritis manifested as ataxia.

Adolescents:

• 100 mg every day for three weeks, then 30 mg per day

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Chronic use of Penicillamine in patients with Wilson Disease:

Children and Adolescents:

• 25 - 50 mg/day.

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Treatment for acute isoniazid consumption with a dose: 

Treatment of coma and seizures brought on by isoniazid

Juniors and teenagers:

Acute ingestion of known amount:

• The amount of pyridoxine administered should be equivalent to the amount of isoniazid consumed, up to a maximum dose of 70 mg/kg (5 grammes).
• Until the maximum dose is supplied or the seizures stop, the complete estimated dose should be given at a rate of 0.5 to 1 gms/minute.
• If further doses are needed to manage the seizures, they can be given every 5 to 10 minutes.
• If a patient responds to the medication (their seizures stop) before the calculated dose is finished, the remaining amount may be given over a 4- to 6-hour period.

Acute ingestion of unknown amount:

• At a rate of 0.5-1 g per minute, a dose of 70 mg/kg up to a maximum of 5 g should be delivered.
• To reduce the CNS toxicity and persistent seizure activity, the dose may be given again every 5 to 10 minutes as necessary.

To stop the coma and convulsions that isoniazid causes in kids:

• The dosage is the same as for treating patients who are exhibiting symptoms.
• Patients who show with symptoms within two hours of taking a hazardous dose of isoniazid should be given a prophylactic dose of pyridoxine.

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Dose for the management of acute intoxication in individuals who consume Gyromitra mushrooms:

Children and Adolescents:

• Up to a total dose of 15–20 gms, the dose may be repeated.
• 25 mg/kg IV dosage.

Pregnancy Risk Factor A

• During pregnancy, it might be used to relieve nausea or vomiting.
• It is a water-soluble vitamin, which can cross the placental boundary.
• Patients who are pregnant require higher levels of pyridoxine.

Pyridoxine (Vitamin B6) use during breastfeeding:

• It is found in breastmilk, and breastfeeding women have higher requirements than non-breastfeeding mothers.
• The inhibition of lactation may be caused by higher doses or administration after delivery.
• Breastfeeding women should avoid parental administration.

Vitamin B6 Dose in Renal Disease:

• The manufacturer has not recommended any dose adjustment in patients with renal disease.

Vitamin B6 Dose in Liver Disease:

• The manufacturer has not recommended any dose adjustment in patients with liver disease.

Side Effects of Vitamin B6

Frequency not defined.

Gastrointestinal:

• Nausea

Central nervous system:

• Drowsiness
• Headache
• Neuropathy
• Paresthesia
• Seizure
• Ataxia

Hepatic:

• Increased serum AST

Endocrine & Metabolic:

• Acidosis
• Folate Deficiency

Hypersensitivity:

• Hypersensitivity reaction

Contraindication to Pyridoxine (Vitamin B6) includes:

Reactions to this formulation's ingredients, including pyridoxine, that cause allergy

Warnings and Precautions

Neuropathy:

• Neurotoxicity can result in permanent peripheral neuropathies if long-term, high doses are taken (more than 2 grams/day).

Vitamin B6 (pyridoxine): Drug Interaction
 

Risk Factor C (Monitor therapy)
Barbiturates	Barbiturates may be broken down more quickly by pyridoxine. There is evidence for elevated pyridoxine doses (200 mg daily, for example).
Fosphenytoin	The metabolism of fosphenytoin may be accelerated by pyridoxine. High pyridoxine doses make this especially apparent (e.g., 80 mg to 200 mg daily)
Phenytoin	Phenytoin's metabolism may be accelerated by pyridoxine. This is particularly noticeable at elevated pyridoxine doses (e.g., 80 mg-200 mg per day)
Risk Factor D (Consider therapy modification)
Altretamine	Altretamine's therapeutic effects may be lessened by pyridoxine. Particularly, the response length may be shortened when altretamine and cisplatin are combined.
Levodopa-Containing Products	Levodopa-containing products' therapeutic effects could be reduced by pyridoxine. Management: Pyridoxine and levodopa shouldn't be used together if a dopa decarboxylase inhibitor (DDI) isn't present. Levodopa and a DDI, such as carbidopa, almost preclude the possibility of this interaction.

Monitoring Parameters:

Monitor the following in patients receiving treatment for isoniazid or gyromitrin-containing mushroom toxicity:

• Neurological exam
• Seizure activity
• Anion gap
• Arterial blood gases
• Electrolytes

How to administer Pyridoxine (Vitamin B6)?

It may be administered orally or as an intramuscular or intravenous injection.

• Patients who have consumed too much Gyromitrin-containing mushroom (fake morel) should get pyridoxine over the course of 15-30 mins.
• Patients with isoniazid toxicity:
  • Pyridoxine should be given in initial doses at a rate of 0.5-1 g per minute. In the absence of the parenteral method, pyridoxine tablets may be grounded into a slurry and given via a nasogastric tube.
  • Acutely poisoned patients with seizures should not be given oral formulation.

Mechanism of action of Vitamin B6:

• It is a pyridoxal precursor that supports the breakdown and synthesis of carbs, proteins, and lipids.
• It helps in the production and maintenance of GABA in the central nervous system as well as the release of glucose that has been accumulated in the liver and muscles.
• It may form glycine, which is a non-toxic metabolite in patients suffering from ethylene glycol poisoning.

It works well-absorbed when taken orally,

it is metabolized the liver converts pyridoxal and pyridoxamine phosphate to pyridoxamine.

 It is a half-life elimination between 15 and 20 days.

excreted primarily in the urine    

International Brands of Vitamin B6:

• AFI-B6
• B(6)-Vicotrat
• Becilan
• Bedoxine
• Bedoyecta
• Beesix
• Benadon
• Bexivit
• Biprin
• Bivit
• Burgerstein Vitamin B6
• Comploment Continus
• Dermo 6
• Dodemina
• Dolvifen
• Farmobion B6
• Glutarase
• Heksavit
• Hexobion 100
• Hysix
• Incremin con hierro
• V. I. 12
• Memosprint
• Natele
• Nuro-B
• Pharmaton
• Pidopidon
• Piridoxina Austral
• Plivit B6
• Poly-B con Vitamina C
• Pyricontin Continus
• Pyridoxin Recip[Tab.]
• Pyridoxin ”Dak”
• Pyridoxine Aguettant
• Pyridoxine Renaudin
• Pyridoxine-Labaz
• Pyrivitol
• Pyroxin
• Reisevit
• Sechvitan
• Tanvimil B6
• Neuro-K-500
• Pyri 500
• Trineurovita
• B6 Agepha
• Neuro-K-250 T.D.
• Vita-B6
• Vitamin B6
• Vitamin B6 Streuli
• Vitamine B6 Richard
• Vitaminum B6
• Xanturenasi
• Neuro-K-250 Vitamin B6
• Neuro-K-50

Pyridoxine brands in Pakistan:

Brand	Pharma company
Amdoxine	Amson
Pyrivit	Global/ Vision
Pyro-6	Medera
Trovit-6	Tagma
Veri-6	Flow pharma
Vita-6	Mendoza
Vitox	Glitz