Uses
Pyridoxine Deficiency
Treatment of vitamin B6 deficiency.
Dietary Requirements
Adequate intake needed to prevent vitamin B6 deficiency.
Adequate intake of pyridoxine can be accomplished through consumption of fortified ready-to-eat cereals; meals containing substantial portions of meat, fish, or poultry; white potatoes and other starchy vegetable; and noncitrus fruits.
Recommended Dietary Allowance (RDA) in adults based on a plasma pyridoxal phosphate concentration of 5 ng/mL.
Adequate intake (AI) established for infants ≤6 months of age based on observed mean vitamin B6 intake of infants fed principally human milk; AI for infants 7–12 months of age based on AI for younger infants and data in adults.
RDA for children 1–18 years of age based on data in adults.
Pyridoxine-dependent Seizures
Treatment of pyridoxine-dependent seizures.
Metabolic Disorders
Xanthurenic aciduria, cystathioninuria, and homocystinuria resulting from genetic abnormalities may respond to high doses of pyridoxine.
Prevention or Treatment of Drug-induced Neurotoxicity
Prevent or treat neuropathy in patients receiving isoniazid. Pyridoxine prophylaxis recommended in isoniazid-treated individuals with nutritional deficiency (e.g., meat and milk-deficient diet), diabetes mellitus, HIV infection, renal failure, alcoholism, and in exclusively breast-fed infants, pregnant women, and lactating women.
Also has been used to prevent or treat neurotoxic adverse effects (e.g., peripheral neuropathy) associated with ethionamide or capecitabine.
Adjunct for treatment of acute toxicity resulting from isoniazid overdosage.
Mushroom Toxicity
Adjunct for treatment of acute toxicity caused by mushrooms† of the genus Gyromitra. Used to correct marked neurologic effects (e.g., seizures, coma) induced by methylhydrazine (produced by hydrolysis of the toxins in these mushrooms).
Dosage and Administration
Administration
Usually administered orally. May be administered by IM, IV, or sub-Q injection when oral administration is not feasible.
Dosage
Available as pyridoxine hydrochloride; dosage expressed in terms of pyridoxine hydrochloride.
Pediatric Patients
Dietary and Replacement Requirements
Oral
Infants ≤6 months of age: Recommended AI is 0.1 mg (0.01 mg/kg) daily.
Infants 7–12 months of age: Recommended AI is 0.3 mg (0.03 mg/kg) daily.
Children 1–3 years of age: RDA is 0.5 mg daily.
Children 4–8 years of age: RDA is 0.6 mg daily.
Children 9–13 years of age: RDA is 1 mg of daily.
Boys 14–18 years of age: RDA is 1.3 mg daily.
Girls 14–18 years of age: RDA is 1.2 mg daily.
Pyridoxine-dependent Seizures
Oral
Maintenance following parenteral administration: 2–100 mg daily has been recommended.
IM or IV
10–100 mg has been recommended. Follow with lifelong oral pyridoxine.
Adults
Pyridoxine Deficiency
Oral
2.5–10 mg daily.
After clinical signs of deficiency are corrected, administer a multivitamin preparation containing 2–5 mg of pyridoxine hydrochloride once daily for several weeks.
IM or IV
10–20 mg daily for 3 weeks.
Follow with a multivitamin preparation containing 2–5 mg of pyridoxine hydrochloride once daily for several weeks.
Dietary and Replacement Requirements
Oral
Men and women 19–50 years of age: RDA is 1.3 mg daily.
Men ≥51 years of age: RDA is 1.7 mg daily.
Women ≥51 years of age: RDA is 1.5 mg daily.
Prevention of Drug-induced Neurotoxicity
Oral
CDC recommends 25 mg daily for certain isoniazid-treated patients.
Isoniazid Overdose
IV followed by IM
Ingestion of >10 g of isoniazid: Dose of pyridoxine hydrochloride equals the amount of isoniazid ingested.
Initially, 4 g IV; followed by 1 g IM every 30 minutes until the entire dose has been given.
Mushroom Toxicity
IV
25 mg/kg infused over 15–30 minutes and repeated as necessary to control effects up to a maximum cumulative dose of 15–20 g daily has been suggested.†
Prescribing Limits
Adults
Long-term (> 2 months) administration of large dosages (≥ 2 g daily) can cause sensory neuropathy or neuronopathy syndromes.
Special Populations
Pregnant Women
RDA for pregnant women is 1.9 mg daily.
Lactating Women
RDA for lactating women is 2 mg daily.Requirements increased in lactating women to ensure adequate concentration of the vitamin in milk (130 ng/mL).
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