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

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

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

            All Interactions Sort By:
             activity indicator 

            Contraindicated (0)

              Serious - Use Alternative (1)

              • selinexor

                selinexor, pyridoxine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              Monitor Closely (11)

              • azithromycin

                azithromycin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

              • cisplatin

                pyridoxine decreases effects of cisplatin by unknown mechanism. Use Caution/Monitor. Use of pyridoxine, vitamin B6 with cisplatin and altretamine (hexamethylmelamine) may not be advisable.

              • clarithromycin

                clarithromycin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

              • dichlorphenamide

                dichlorphenamide, pyridoxine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Both drugs can cause metabolic acidosis.

              • erythromycin base

                erythromycin base will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

              • erythromycin ethylsuccinate

                erythromycin ethylsuccinate will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

              • erythromycin lactobionate

                erythromycin lactobionate will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

              • erythromycin stearate

                erythromycin stearate will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

              • levodopa

                pyridoxine decreases levels of levodopa by increasing metabolism. Use Caution/Monitor.

              • omadacycline

                pyridoxine will decrease the level or effect of omadacycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Separate dosing of tetracyclines from these products.

              • roxithromycin

                roxithromycin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

              Minor (62)

              • amikacin

                amikacin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • amiodarone

                pyridoxine increases toxicity of amiodarone by unspecified interaction mechanism. Minor/Significance Unknown. Increased risk of photosensitivity.

              • aztreonam

                aztreonam will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • bazedoxifene/conjugated estrogens

                bazedoxifene/conjugated estrogens decreases levels of pyridoxine by altering metabolism. Minor/Significance Unknown.

              • cefadroxil

                cefadroxil will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • cefamandole

                cefamandole will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • cefotetan

                cefotetan will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • cefpirome

                cefpirome will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • ceftibuten

                ceftibuten will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • cephalexin

                cephalexin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • chlorhexidine oral

                chlorhexidine oral will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • ciprofloxacin

                ciprofloxacin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • clindamycin

                clindamycin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • conjugated estrogens

                conjugated estrogens decreases levels of pyridoxine by altering metabolism. Minor/Significance Unknown.

              • conjugated estrogens, vaginal

                conjugated estrogens, vaginal decreases levels of pyridoxine by altering metabolism. Minor/Significance Unknown.

              • dapsone

                dapsone will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • demeclocycline

                demeclocycline will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • doxycycline

                doxycycline will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • ertapenem

                ertapenem will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • estradiol

                estradiol decreases levels of pyridoxine by altering metabolism. Minor/Significance Unknown.

              • estrogens conjugated synthetic

                estrogens conjugated synthetic decreases levels of pyridoxine by altering metabolism. Minor/Significance Unknown.

              • estrogens esterified

                estrogens esterified decreases levels of pyridoxine by altering metabolism. Minor/Significance Unknown.

              • estropipate

                estropipate decreases levels of pyridoxine by altering metabolism. Minor/Significance Unknown.

              • ethotoin

                pyridoxine decreases levels of ethotoin by increasing metabolism. Minor/Significance Unknown. High dose of pyridoxine (vitamin B6), >=200 mg/day.

              • fleroxacin

                fleroxacin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • fosfomycin

                fosfomycin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • fosphenytoin

                pyridoxine decreases levels of fosphenytoin by increasing metabolism. Minor/Significance Unknown. High dose of pyridoxine (vitamin B6), >=200 mg/day.

              • gemifloxacin

                gemifloxacin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • gentamicin

                gentamicin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • hydralazine

                hydralazine decreases levels of pyridoxine by unspecified interaction mechanism. Minor/Significance Unknown.

              • isoniazid

                isoniazid decreases levels of pyridoxine by unspecified interaction mechanism. Minor/Significance Unknown. If INH dose >10 mg/kg/day, supplement 50 100mg pyridoxine/day.

              • levofloxacin

                levofloxacin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • linezolid

                linezolid will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • meropenem

                meropenem will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • meropenem/vaborbactam

                meropenem/vaborbactam will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • mestranol

                mestranol decreases levels of pyridoxine by altering metabolism. Minor/Significance Unknown.

              • metronidazole

                metronidazole will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • minocycline

                minocycline will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • moxifloxacin

                moxifloxacin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • neomycin PO

                neomycin PO will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • nitrofurantoin

                nitrofurantoin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • ofloxacin

                ofloxacin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • oxytetracycline

                oxytetracycline will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • paromomycin

                paromomycin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • penicillamine

                penicillamine decreases levels of pyridoxine by unspecified interaction mechanism. Minor/Significance Unknown.

              • phenobarbital

                pyridoxine decreases levels of phenobarbital by increasing metabolism. Minor/Significance Unknown.

              • phenytoin

                pyridoxine decreases levels of phenytoin by increasing metabolism. Minor/Significance Unknown. High dose of pyridoxine (vitamin B6), >=200 mg/day.

              • pivmecillinam

                pivmecillinam will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • quinupristin/dalfopristin

                quinupristin/dalfopristin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • streptomycin

                streptomycin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • sulfadiazine

                sulfadiazine will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • sulfamethoxazole

                sulfamethoxazole will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • sulfisoxazole

                sulfisoxazole will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • teicoplanin

                teicoplanin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • temocillin

                temocillin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • tetracycline

                tetracycline will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • theophylline

                theophylline decreases levels of pyridoxine by altering metabolism. Minor/Significance Unknown.

              • ticarcillin

                ticarcillin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • tigecycline

                tigecycline will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • tobramycin

                tobramycin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • trimethoprim

                trimethoprim will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • vancomycin

                vancomycin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

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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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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
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              50 mg tablet
              pyridoxine (vitamin B6) injection
              -
              100 mg/mL vial
              pyridoxine (vitamin B6) oral
              -
              25 mg tablet
              pyridoxine (vitamin B6) oral
              -
              50 mg tablet
              pyridoxine (vitamin B6) oral
              -
              100 mg tablet
              pyridoxine (vitamin B6) oral
              -
              50 mg tablet

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Select a drug:
              Patient Education
              pyridoxine (vitamin B6) injection

              NO MONOGRAPH AVAILABLE AT THIS TIME

              USES: Consult your pharmacist.

              HOW TO USE: Consult your pharmacist.

              SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Consult your pharmacist.

              DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

              NOTES: No monograph available at this time.

              MISSED DOSE: Consult your pharmacist.

              STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

              Information last revised July 2016. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

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              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.
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              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the 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.