How to treat Pyridoxine (Vitamin B6) deficiency?

From the Guidelines

To treat Pyridoxine (Vitamin B6) deficiency, initial doses of oral vitamin B6 (pyridoxine) 50 to 200 mg per day are recommended, with lifelong maintenance doses of 10 to 100 mg per day. This approach is based on the most recent and highest quality evidence available, as indicated by studies published in the journal Blood 1. The treatment should also involve management of iron overload, which can be achieved through phlebotomy.

Key Considerations

• Initial treatment with pharmacologic doses of pyridoxine (50 to 200 mg per day) is recommended, with occasional high doses (up to 300 mg per day) considered for certain patients 1.
• Lifelong supplementation with pyridoxine 10 to 100 mg daily is recommended in case of pyridoxine responsiveness 1.
• Iron loading should be treated, preferably by phlebotomies, to prevent compromise of mitochondrial function and heme biosynthesis 1.
• Patients should be monitored for neurotoxicity, as high doses of pyridoxine can cause nerve damage 1.

Additional Recommendations

• Increase B6-rich foods in the diet, including poultry, fish, potatoes, chickpeas, bananas, and fortified cereals.
• Take the supplement with food to improve absorption and reduce stomach upset.
• Consult a healthcare provider before self-supplementing, especially if experiencing symptoms like skin rashes, cracked lips, depression, confusion, or neuropathy.

From the FDA Drug Label

DOSAGE & ADMINISTRATION Pyridoxine Hydrochloride Injection may be administered intramuscularly or intravenously. In cases of dietary deficiency, the dosage is 10 to 20 mg daily for 3 weeks. The vitamin B6 dependency syndrome may require a therapeutic dosage of as much as 600 mg a day and a daily intake of 30 mg for life. In deficiencies due to INH, the dosage is 100 mg daily for 3 weeks followed by a 30 mg maintenance dose daily

To treat Pyridoxine (Vitamin B6) deficiency, the recommended dosage is:

• 10 to 20 mg daily for 3 weeks in cases of dietary deficiency 2
• 100 mg daily for 3 weeks followed by a 30 mg maintenance dose daily in deficiencies due to INH 2
• Up to 600 mg a day for vitamin B6 dependency syndrome, with a daily intake of 30 mg for life 2 It is also recommended to correct poor dietary habits and prescribe an adequate, well-balanced diet 2.

From the Research

Treatment of Pyridoxine (Vitamin B6) Deficiency

• The treatment of pyridoxine deficiency involves supplementation with vitamin B6, with the goal of maintaining a stable serum PLP level between 30 and 60 nmol/L or 7.4 and 15 μg/L 3.
• PLP-based supplements are preferred over pyridoxine supplements due to their minimal neurotoxicity observed in neuronal cell viability tests 3.
• Weekly administration of low doses (50-100 mg) of PLP-based supplements is recommended to prevent toxicity, as B6 metabolites have a long half-life 3.
• In cases of pyridoxine deficiency, intravenous administration of pyridoxine can result in a dramatic cessation of seizures 4.
• Patients with disorders leading to B6-responsive seizures, such as pyridox(am)ine phosphate oxidase deficiency, may require lifelong dependency on supraphysiological vitamin B6 supply 5.

Dosage and Administration

• The currently recommended daily allowance of B6 (1.5-2 mg/d) from dietary sources may not be sufficient for many elderly patients and patients with comorbid conditions 3.
• High doses of vitamin B6 (>100 nmol/L or 25 μg/L) can lead to neurotoxicity, and therefore, careful monitoring of plasma B6 levels is necessary 3, 6.
• Vitamin B6 supplementation should be administered under medical supervision, especially in patients with a history of peripheral neuropathy or other neurological disorders 6.

Monitoring and Precautions

• Plasma B6 levels should be ordered as part of the workup of any unexplained anemia before labeling it as "anemia of chronic disease" 3.
• B6 supplementation is also crucial in the management of chronic Mg deficiency resistant to therapy 3.
• Patients with vitamin B6 deficiency should be monitored for signs of neurotoxicity, such as peripheral neuropathy, and dosage adjustments should be made accordingly 6.