|PYRIDOXINE HYDROCHLORIDE (VITAMIN B6)
Classifications: vitamin; Therapeutic:vitamin b6 replacement
Pregnancy Category: A (C if greater than RDA)
25 mg, 50 mg, 100 mg, 250 mg, 500 mg tablets; 100 mg/mL injection
Water-soluble complex of three closely related compounds with B6 activity. Considered essential to human nutrition, although a deficiency syndrome is not well defined. Converted in body
to pyridoxal, a coenzyme that functions in protein, fat, and carbohydrate metabolism and in facilitating release of glycogen
from liver and muscle. In protein metabolism, participates in many enzymatic transformations of amino acids and conversion
of tryptophan to niacin and serotonin. Aids in energy transformation in brain and nerve cells, and is thought to stimulate
Evaluated by improvement of B6 deficiency manifestations: Nausea, vomiting, skin lesions resembling those of riboflavin and niacin deficiency, edema,
CNS symptoms, hypochromic microcytic anemia.
Prophylaxis and treatment of pyridoxine deficiency, as seen with inadequate dietary intake, drug-induced deficiency (e.g.,
isoniazid, oral contraceptives), and inborn errors of metabolism (vitamin B6dependent convulsions or anemia). Also to prevent chloramphenicol-induced optic neuritis, to treat acute toxicity
caused by overdosage of cycloserine, hydralazine, isoniazid (INH); alcoholic polyneuritis; sideroblastic anemia associated
with high serum iron concentration. Has been used for management of many other conditions ranging from nausea and vomiting
in radiation sickness and pregnancy to suppression of postpartum lactation.
Pregnancy [category A (C if >RDA)].
Renal impairment; neonatal prematurity with renal impairment; cardiac disease.
Route & Dosage
Adult: PO/IM/IV 1020 mg/d x 23 wk
Child: PO 525 mg/d x 3 wk, then 1.52.5 mg/d
Pyridoxine Deficiency Syndrome
Adult: PO/IM/IV Initial dose up to 600 mg/d may be required; then up to 50 mg/d
Adult: PO/IM/IV 100 mg/d x 3 wk, then 30 mg/d
Child: PO 1050 mg/d x 3 wk, then 12 mg/kg/d
Neonate/Infant: PO/IM/IV 50100 mg/d
- Ensure that sustained release and enteric forms are not chewed or crushed. Must be swallowed whole.
- Give deep IM into a large muscle.
PREPARE: Direct: Give undiluted. Continuous: May be added to most standard IV solutions.
ADMINISTER: Direct: Give at a rate of 50 mg or fraction thereof over 60 seconds. Continuous: Give according to ordered rate for infusion.
- Store at 15°30° C (59°86° F) in tight, light-resistant containers. Avoid freezing.
Adverse Effects (≥1%)Body as a Whole:
Paresthesias, slight flushing or feeling of warmth, temporary burning or stinging pain in injection site. CNS:
Somnolence seizures (particularly following large parenteral
Low folic acid
InteractionsDrug: Isoniazid, cycloserine, penicillamine, hydralazine
and oral contraceptives
, may increase pyridoxine requirements; may reverse or antagonize therapeutic effects of levodopa.
Readily from GI tract. Distribution:
Stored in liver; crosses placenta. Metabolism:
In liver. Elimination:
Assessment & Drug Effects
- Monitor neurological status to determine therapeutic effect in deficiency states.
- Record a complete dietary history so poor eating habits can be identified and corrected (a single vitamin deficiency is
rare; patient can be expected to have multiple vitamin deficiencies).
- Lab tests: Periodic Hct and Hgb, and serum iron.
Patient & Family Education
- Learn rich dietary sources of vitamin B6: Yeast, wheat germ, whole grain cereals, muscle and glandular meats (especially liver), legumes, green vegetables, bananas.
- Do not self-medicate with vitamin combinations (OTC) without first consulting physician.