Pyridoxine Hydrochloride

Name: Pyridoxine Hydrochloride

Uses for Pyridoxine Hydrochloride

Pyridoxine Deficiency

Treatment of vitamin B6 deficiency.a b

Dietary Requirements

Adequate intake needed to prevent vitamin B6 deficiency.157

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.157

Recommended Dietary Allowance (RDA) in adults based on a plasma pyridoxal phosphate concentration of 5 ng/mL.157

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.157

RDA for children 1–18 years of age based on data in adults.157

Pyridoxine-dependent Seizures

Treatment of pyridoxine-dependent seizures.159 a b

Metabolic Disorders

Xanthurenic aciduria, cystathioninuria, and homocystinuria resulting from genetic abnormalities may respond to high doses of pyridoxine.a

Prevention or Treatment of Drug-induced Neurotoxicity

Prevent or treat neuropathy in patients receiving isoniazid.a b 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.c d

Also has been used to prevent or treat neurotoxic adverse effects (e.g., peripheral neuropathy) associated with ethionamide or capecitabine.a b

Adjunct for treatment of acute toxicity resulting from isoniazid overdosage.a b

Mushroom Toxicity

Adjunct for treatment of acute toxicity caused by mushrooms† of the genus Gyromitra.153 154 155 Used to correct marked neurologic effects (e.g., seizures, coma) induced by methylhydrazine (produced by hydrolysis of the toxins in these mushrooms).153 154 155

Pyridoxine Hydrochloride Dosage and Administration

Administration

Usually administered orally.a May be administered by IM, IV, or sub-Q injection when oral administration is not feasible.a b

Dosage

Available as pyridoxine hydrochloride; dosage expressed in terms of pyridoxine hydrochloride.a b

Pediatric Patients

Dietary and Replacement Requirements Oral

Infants ≤6 months of age: Recommended AI is 0.1 mg (0.01 mg/kg) daily.157

Infants 7–12 months of age: Recommended AI is 0.3 mg (0.03 mg/kg) daily.157

Children 1–3 years of age: RDA is 0.5 mg daily.157

Children 4–8 years of age: RDA is 0.6 mg daily.157

Children 9–13 years of age: RDA is 1 mg of daily.157

Boys 14–18 years of age: RDA is 1.3 mg daily.157

Girls 14–18 years of age: RDA is 1.2 mg daily.157

Pyridoxine-dependent Seizures Oral

Maintenance following parenteral administration: 2–100 mg daily has been recommended.a

IM or IV

10–100 mg has been recommended.a Follow with lifelong oral pyridoxine.a

Adults

Pyridoxine Deficiency Oral

2.5–10 mg daily.a

After clinical signs of deficiency are corrected, administer a multivitamin preparation containing 2–5 mg of pyridoxine hydrochloride once daily for several weeks.a

IM or IV

10–20 mg daily for 3 weeks.b

Follow with a multivitamin preparation containing 2–5 mg of pyridoxine hydrochloride once daily for several weeks.b

Dietary and Replacement Requirements Oral

Men and women 19–50 years of age: RDA is 1.3 mg daily.157

Men ≥51 years of age: RDA is 1.7 mg daily.157

Women ≥51 years of age: RDA is 1.5 mg daily.157

Prevention of Drug-induced Neurotoxicity Oral

CDC recommends 25 mg daily for certain isoniazid-treated patients.c

Isoniazid Overdose IV followed by IM

Ingestion of >10 g of isoniazid: Dose of pyridoxine hydrochloride equals the amount of isoniazid ingested.b

Initially, 4 g IV; followed by 1 g IM every 30 minutes until the entire dose has been given.b

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.153 154 155

Prescribing Limits

Adults

Long-term (> 2 months) administration of large dosages (≥ 2 g daily) can cause sensory neuropathy or neuronopathy syndromes.115 120 123

Special Populations

Pregnant Women

RDA for pregnant women is 1.9 mg daily.157

Lactating Women

RDA for lactating women is 2 mg daily.157 Requirements increased in lactating women to ensure adequate concentration of the vitamin in milk (130 ng/mL).157

Interactions for Pyridoxine Hydrochloride

For information regarding isoniazid, see Prevention or Treatment of Drug-induced Neurotoxicity under Uses and Prevention of Drug-induced Neurotoxicity and Isoniazid Overdosage under Dosage and Administration.

Specific Drugs and Laboratory Tests

Drug

Interaction

Comments

Anticonvulsants (phenobarbital, phenytoin)

Decreased plasma concentrations of the anticonvulsanta

Levodopa

Pyridoxine interferes with therapeutic effect of levodopaa

Interaction does not occur with levodopa/carbidopaa

Test for urobilinogen using Ehrlich's reagent

Possible false-positive resulta

Stability

Storage

Oral

Tablets

Well-closed container at <40°C ; maintain at 15–30°C.a Protect from light.a

Parenteral

Solution

20–25°C. b Protect from light.b

Advice to Patients

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs as well as concomitant illness.a

  • Importance of proper dietary habits, including taking appropriate AI or RDA of vitamin B6.a

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.a

  • Importance of informing patients of other important precautionary information.a (See Cautions.)

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