pyridoxine (Rx, OTC)

Brand and Other Names:vitamin B6, Nestrex
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablets

  • 25mg
  • 50mg
  • 100mg
  • 250mg
  • 500mg

tablets, extended release

  • 200mg

capsule

  • 250mg
more...

RDA

Males

  • <50 years old: 1.3 mg/day
  • >50 years old: 1.7 mg/day

Females

  • <50 years old: 1.3 mg/day
  • >50 years old: 1.5 mg/day
  • Pregnant: 1.9 mg/day
  • Lactation: 2mg

Pyridoxine Deficiency

10-20 mg/day IV/IM for 3 weeks

2.5-10 mg/day PO

Nausea in Pregnancy

10-25 mg PO q8hr

Prevention of Peripheral Neuropathy

Patients treated with isoniazid for Mycobacterium tuberculosis: 25-50 mg/day PO

Seizures (Orphan)

Treatment of pyridoxine dependent seizures

Orphan indication sponsor

  • NBI Pharmaceuticals, Inc; 1087 Stoneridge Drive; Bozeman, MT 59718

Dosage Forms & Strengths

tablets

  • 25mg
  • 50mg
  • 100mg
  • 200mg
  • 250mg
  • 500mg

tablets, extended release

  • 200mg

capsule

  • 250mg
more...

RDA

<6 months: 0.1 mg/day

6-12 months: 0.3 mg/day

1-3 years: 0.5 mg/day

3-8 years: 0.6 mg/day

8-13 years: 1 mg/day

13-18 years: 1.3 mg/day (male); 1.5 mg/day (female)

Isoniazid-Induced Seizures/Coma

Dose of pyridoxine is equal to amount of isoniazid ingested

Administer at rate of 0.5-1 g/min until seizures stop or maximum initial dose (70 mg/kg) administered; may administer q5-10min PRN to control persistent seizure activity and/or CNS toxicity

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Interactions

Interaction Checker

and pyridoxine

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Headache

            Seizure (from very large IV dose)

            Somnolence

            Decreased folic acid

            Acidosis

            Increased hepatic AST

            Nausea

            Paresthesia

            Neuropathy

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            Warnings

            Contraindications

            Hypersensitivity

            Cautions

            Long-term large doses associated with induced neuropathy

            Use caution in patients with impaired renal function and neonates (some parental products contain aluminum)

            May cause dependence/withdrawal

            Pyridoxine deficiency rare (enaluate for other deficiencies)

            Dependence and withdrawal associated with >200 mg/day

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            Pregnancy & Lactation

            Pregnancy Category: A/C-when exceeding RDA recommendations

            Lactation: Safe

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Nutrition

            Sources: Beef liver, pork, baked potato, spinach, banana, cereals, milk, fish, avocado

            Function: Cofactor in enzymatic reactions

            Deficiency: Inflammation of mouth, lips, tongue; anxiety, depression, confusion; anemia; rarely seizures

            Deficiency may be caused by some medications (isoniazid, alcohol, penicillamine, theophylline)

            Reduced by: Estrogens, stewing/boiling

            Toxicity: >200 mg/day can lead to nerve damage & photosensitivity

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            Pharmacology

            Mechanism of Action

            Precursor of pyridoxal; plays a role in metabolism of proteins, carbohydrates, and fats; aids in the sythesis of GABA

            Aids in release of liver and muscle stored glycogen

            Pharmacokinetics

            Absorption (parenteral/enteral): Well absorbed

            Half-life: 15-20 days

            Excretion: Urine

            Metabolism: Liver to pyridoxal phosphate and pyridoxamine phosphate (active forms)

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
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            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.