Pyridoxine HCl (B₆)

A to Z Drug Facts

Pyridoxine HCl (B₆)

	Action
	Indications
	Contraindications
	Route/Dosage
	Interactions
	Lab Test Interferences
	Adverse Reactions
	Precautions
Patient Care Considerations
	Administration/Storage
	Assessment/Interventions
	Patient/Family Education

(peer-ih-DOX-een HIGH-droe-KLOR-ide)

Aminoxin, Nestrex, Hexa-Betalin

Class: Vitamin

Action Vitamin B₆ functions as coenzyme in amino acid, carbohydrate and lipid metabolism.

Indications Pyridoxine deficiency, including inadequate diet, drug-induced causes (eg, isoniazid, hydralazine, oral contraceptives) or inborn errors of metabolism. Parenteral use is indicated when oral therapy is not feasible. Unlabeled use(s): Treatment of hydrazine poisoning, PMS, hyperoxaluria type I, nausea and vomiting in pregnancy, sideroblastic anemia associated with high serum iron, carpal tunnel syndrome, tardive dyskinesia.

Contraindications Standard considerations.

Route/Dosage

Dietary Deficiency

ADULTS: PO/IM/IV 10 to 20 mg/day for 3 wk.

Drug-Induced Deficiency Anemia or Neuritis

ADULTS: PO/IM/IV 100 to 200 mg/day for 3 wk; follow with 25 to 100 mg/day.

Neuropathy

ADULTS: PO/IM/IV 50 to 200 mg/day.

Vitamin B₆ Dependency Syndrome

ADULTS: PO/IM/IV 600 mg, followed by 30 mg/day for life. Dependency has been noted in adults administered 200 mg/day. PYRIDOXINE-DEPENDENT INFANTS: IM/IV 10 to 100 mg, followed by 2 to 100 mg/day.

Metabolic Disorders

ADULTS: PO/IM/IV 100 to 500 mg/day.

Isoniazid (INH) Poisoning

ADULTS & CHILDREN: IV 4 gm IV followed by 1 gm IM q 30 min until pyridoxine dose equal to INH dose has been given.

Interactions

Cycloserine, INH, hydralazine, oral contraceptives, penicillamine: Increased need for pyridoxine. Levodopa: Decreased effect of levodopa. (Interaction does not occur with levodopa/carbidopa in combination with pyridoxine.) Phenytoin: Phenytoin serum levels may be decreased. Parenteral: INCOMPATIBILITIES: Incompatible with alkaline solutions, iron salts and oxidizing agents.

Lab Test Interferences May result in false-positive urobilinogen in the spot test using Ehrlich's reagent.

Adverse Reactions

CNS: Neuropathy; unstable gait; drowsiness; somnolence. EENT: Perioral numbness. OTHER: Numbness of feet; decreased sensation to touch, temperature or vibration; paresthesia; low serum folic acid levels; burning/stinging at IM injection site; photoallergic reaction; ataxia.

Precautions

Pregnancy: Category A. (Category C in doses that exceed the RDA.) Lactation: Excreted in breast milk; may inhibit lactation. Children: Safety and efficacy not established in doses exceeding nutritional requirements.

PATIENT CARE CONSIDERATIONS

Administration/Storage

Instruct patient to swallow sustained-release preparation whole and not to break, crush or chew.
When giving via IM route, rotate sites.
IV preparation may be given undiluted or added to standard compatible IV solutions.
Store all forms of drug at room temperature in tightly-closed, light-resistant containers. Avoid freezing injection.

Assessment/Interventions

Obtain patient history, including drug history and any known allergies.
Assess for signs of vitamin B₆ deficiency (eg, irritability, seizures, anemia, dermatitis, nausea, vomiting) prior to and during therapy.
Institute seizure precautions in pyridoxine-dependent infants.
Obtain dietary consultation to review importance of well-balanced meals and sources of B₆ prior to discharge home.

OVERDOSAGE: SIGNS & SYMPTOMS
	Ataxia, sensory neuropathy

Patient/Family Education

Emphasize importance of complying with prescribed dietary recommendations.
Teach patient about foods high in B₆ (whole grain cereals, meat [eg, liver,] potatoes, green vegetables, legumes [eg, lima beans], yeast and bananas).
If patient is self-medicating with vitamin supplements, caution that megadosing may cause side effects such as unsteady gait, impaired hand coordination and numbness of feet.