Pyridoxine (injection)

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Pyridoxine (injection)
Adult Indications & Dosage
Pediatric Indications & Dosage
Contraindications
Warnings & Precautions
Adverse Reactions
Drug Interactions
Use in Specific Populations
Administration & Monitoring
Overdosage
Pharmacology
Clinical Studies
How Supplied
Images
Patient Counseling Information
Precautions with Alcohol
Brand Names
Look-Alike Names

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alberto Plate [2]

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Overview

Pyridoxine (injection) is a nutritive agent of the vitamin B family that is FDA approved for the treatment of inadequate dietary intake, drug-induced deficiency, as from isoniazid (INH) or oral contraceptives, inborn errors of metabolism, e.g., vitamin B6 dependent convulsions or vitamin B6 responsive anemia. The parenteral route is indicated when oral administration is not feasible as in anorexia, nausea and vomiting, and preoperative and postoperative conditions. It is also indicated when gastrointestinal absorption is impaired. Common adverse reactions include decreased folic acid, paresthesia and somnolence.

Adult Indications and Dosage

FDA-Labeled Indications and Dosage (Adult)

Dietary Deficiency
  • 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. Follow-up treatment is recommended daily for several weeks with an oral therapeutic multivitamin preparation containing 2 to 5 mg pyridoxine. Poor dietary habits should be corrected, and an adequate, well balanced diet should be prescribed.
Vitamine B6 Dependency Syndrome
  • 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.
Drug-Induced Deficiency
  • In deficiencies due to INH, the dosage is 100 mg daily for 3 weeks followed by a 30 mg maintenance dose daily.
Poisoning
  • In poisoning caused by ingestion of more than 10 g of INH, an equal amount of pyridoxine should be given — 4 g intravenously followed by 1 g intramuscularly every 30 minutes.

Off-Label Use and Dosage (Adult)

Guideline-Supported Use

Hemopoietic stem cell transplant - Tuberculosis; Prophylaxis
  • Dosage: 25 to 50 mg orally once daily for 9 months in combination with Isoniazid (INH) Isoniazid 5 mg/kg/day orally or intramuscularly for 9 months (ie, for 270 doses); maximum dose, 300 mg/day [1]

Non–Guideline-Supported Use

AIDS Virus Infection Associated With Pregnancy
Treatment and Prophylaxis of Peripheral Polyneuropathy
  • Dosage: 60 mg/day for 4 weeks[2]
Hydrazine Intoxication
  • Dosage: 5 g IV diluted in 500 mL of 5% dextrose[3]
Pregnancy Morning Sickness
  • Dosage: 30 milligrams/day

Pediatric Indications and Dosage

FDA-Labeled Indications and Dosage (Pediatric)

There is limited information regarding Pyridoxine (injection) FDA-Labeled Indications and Dosage (Pediatric) in the drug label.

Off-Label Use and Dosage (Pediatric)

Guideline-Supported Use

Hemopoietic stem cell transplant - Tuberculosis; Prophylaxis
  • Dosage: 25 to 50 mg orally once daily for 9 months in combination with Isoniazid (INH) Isoniazid 5 mg/kg/day orally or intramuscularly for 9 months (ie, for 270 doses); maximum dose, 300 mg/day [4]

Non–Guideline-Supported Use

Hyperhomocysteinemia, Associated with Sickle Cell Disease
  • Dosage: 6 mg (4.6-10.0 US 1998 RDA)[5].
Treatment of infantile spasms with high-dosage vitamin B6
  • Dosage[6]
    • Week 1: 100 mg/day PO q24h
    • Week 2-5: 300 mg/day PO q24h

Contraindications

  • A history of sensitivity to pyridoxine or to any of the ingredients in Pyridoxine Hydrochloride Injection, USP is a contraindication.

Warnings

  • This product contains aluminum that may be toxic. Aluminum may reach toxic levels with prolonged parenteral administration if kidney function is impaired. Premature neonates are particularly at risk because their kidneys are immature, and they require large amounts of calcium and phosphate solutions, which contain aluminum.
  • Research indicates that patients with impaired kidney function, including premature neonates, who receive parenteral levels of aluminum at greater than 4 to 5 mcg/kg/day accumulate aluminum at levels associated with central nervous system and bone toxicity. Tissue loading may occur at even lower rates of administration.

Adverse Reactions

Clinical Trials Experience

Postmarketing Experience

There is limited information regarding Pyridoxine (injection) Postmarketing Experience in the drug label.

Drug Interactions

  • Pyridoxine supplements should not be given to patients receiving levodopa, because the action of the latter drug is antagonized by pyridoxine. However, this vitamin may be used concurrently in patients receiving a preparation containing both carbidopa and levodopa.

Use in Specific Populations

Pregnancy

Pregnancy Category (FDA): A

  • The requirement for pyridoxine appears to be increased during pregnancy. Pyridoxine is sometimes of value in the treatment of nausea and vomiting of pregnancy.


Pregnancy Category (AUS): There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Pyridoxine (injection) in women who are pregnant.

Labor and Delivery

There is no FDA guidance on use of Pyridoxine (injection) during labor and delivery.

Nursing Mothers

  • The need for pyridoxine is increased during lactation. It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when pyridoxine hydrochloride is administered to a nursing woman.

Pediatric Use

There is no FDA guidance on the use of Pyridoxine (injection) in pediatric settings.

Geriatic Use

There is no FDA guidance on the use of Pyridoxine (injection) in geriatric settings.

Gender

There is no FDA guidance on the use of Pyridoxine (injection) with respect to specific gender populations.

Race

There is no FDA guidance on the use of Pyridoxine (injection) with respect to specific racial populations.

Renal Impairment

There is no FDA guidance on the use of Pyridoxine (injection) in patients with renal impairment.

Hepatic Impairment

There is no FDA guidance on the use of Pyridoxine (injection) in patients with hepatic impairment.

Females of Reproductive Potential and Males

There is no FDA guidance on the use of Pyridoxine (injection) in women of reproductive potentials and males.

Immunocompromised Patients

There is no FDA guidance one the use of Pyridoxine (injection) in patients who are immunocompromised.

Administration and Monitoring

Administration

There is limited information regarding Pyridoxine (injection) Administration in the drug label.

Monitoring

There is limited information regarding Pyridoxine (injection) Monitoring in the drug label.

IV Compatibility

There is limited information regarding the compatibility of Pyridoxine (injection) and IV administrations.

Overdosage

  • Pyridoxine given to animals in amounts of 3 to 4 g/kg of body weight produces convulsions and death. In man, a dose of 25 mg/kg of body weight is well tolerated.

Pharmacology

Pyridoxine CHembox.png

Mechanism of Action

  • Natural substances that have vitamin B6 activity are pyridoxine in plants and pyridoxal or pyridoxamine in animals. All 3 are converted to pyridoxal phosphate by the enzyme pyridoxal kinase. The physiologically active forms of vitamin B6 are pyridoxal phosphate (codecarboxylase) and pyridoxamine phosphate. Riboflavin is required for the conversion of pyridoxine phosphate to pyridoxal phosphate.

Vitamin B6 acts as a coenzyme in the metabolism of protein, carbohydrate, and fat. In protein metabolism, it participates in the decarboxylation of amino acids, conversion of tryptophan to niacin or to serotonin (5-hydroxtryptamine), deamination, and transamination and transulfuration of amino acids. In carbohydrate metabolism, it is responsible for the breakdown of glycogen to glucose-1-phosphate.

Structure

  • The chemical name is 2-methyl-3-hydroxy-4,5-bis (hydroxymethyl) pyridine hydrochloride. The structural formula is:
Pyridoxine Structure.png

Pharmacodynamics

There is limited information regarding Pyridoxine (injection) Pharmacodynamics in the drug label.

Pharmacokinetics

  • The total adult body pool consists of 16 to 25 mg of pyridoxine. Its half-life appears to be 15 to 20 days. Vitamin B6 is degraded to 4-pyridoxic acid in the liver. This metabolite is excreted in the urine.
  • The need for pyridoxine increases with the amount of protein in the diet. The tryptophan load test appears to uncover early vitamin B6 deficiency by detecting xanthinurea. The average adult minimum daily requirement is about 1.25 mg. The ‘‘Recommended Dietary Allowance’’ of the National Academy of Sciences is estimated to be as much as 2.2 mg for adults and 2.5 mg for pregnant and lactating women. The requirements are more in persons having certain genetic defects or those being treated with isonicotinic acid hydrazide (INHJ) or oral contraceptives.

Nonclinical Toxicology

There is limited information regarding Pyridoxine (injection) Nonclinical Toxicology in the drug label.

Clinical Studies

There is limited information regarding Pyridoxine (injection) Clinical Studies in the drug label.

How Supplied

  • How Supplied - Pyridoxine .png

Storage

  • Store at 20° to 25°C (68° to 77°F) [see USP Controlled Room Temperature].

Images

Drug Images

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Package and Label Display Panel

Pyridoxine FDA Label.png

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Patient Counseling Information

There is limited information regarding Pyridoxine (injection) Patient Counseling Information in the drug label.

Precautions with Alcohol

Alcohol-Pyridoxine hydrochloride interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.

Brand Names

Look-Alike Drug Names

There is limited information regarding Pyridoxine (injection) Look-Alike Drug Names in the drug label.

Drug Shortage Status

Price

References

The contents of this FDA label are provided by the National Library of Medicine.

  1. "Guidelines for Preventing Infectious Complications among Hematopoietic Cell Transplantation Recipients: A Global Perspective" (PDF).
  2. Okada H, Moriwaki K, Kanno Y, Sugahara S, Nakamoto H, Yoshizawa M; et al. (2000). "Vitamin B6 supplementation can improve peripheral polyneuropathy in patients with chronic renal failure on high-flux haemodialysis and human recombinant erythropoietin". Nephrol Dial Transplant. 15 (9): 1410–3. PMID 10978399.
  3. Nagappan R, Riddell T (2000). "Pyridoxine therapy in a patient with severe hydrazine sulfate toxicity". Crit Care Med. 28 (6): 2116–8. PMID 10890675.
  4. "Guidelines for Preventing Infectious Complications among Hematopoietic Cell Transplantation Recipients: A Global Perspective" (PDF).
  5. van der Dijs FP, Fokkema MR, Dijck-Brouwer DA, Niessink B, van der Wal TI, Schnog JJ; et al. (2002). "Optimization of folic acid, vitamin B(12), and vitamin B(6) supplements in pediatric patients with sickle cell disease". Am J Hematol. 69 (4): 239–46. PMID 11921017.
  6. Pietz J, Benninger C, Schäfer H, Sontheimer D, Mittermaier G, Rating D (1993). "Treatment of infantile spasms with high-dosage vitamin B6". Epilepsia. 34 (4): 757–63. PMID 8330589.

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