Product Details

Pyridoxine HCl (B6)

(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.

 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.

 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.

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David S. Tatro
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