pyridoxine (Antidote) (Rx)

Brand and Other Names:vitamin B6 (Antidote)
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 100mg/mL

tablets

  • 25mg
  • 50mg
  • 100mg
  • 200mg
  • 250mg
  • 500mg

tablets, sustained release

  • 500mg

Isoniazid (INH) Overdose

1 g per gram INH ingested or 70 mg/kg IV if unknown, may require 1 g q30min; not to exceed 5 g with unclear history

Prevention of Drug-Induced Neuritis

10-50 mg/day PO (penicillamine or INH); 100-300 mg/day (cycloserine)

Ethylene Glycol Toxicity

100 mg IV q6hr for 2 days

Gyromitrin Poisoning

25 mg/kg IV infusion over 15-30 min; repeat PRN up to 15-20 g/day

Use in conjunction with benzodiazepines, phenobarbital

Other Indications & Uses

Toxicity due cycloserine OD, penicillamine OD, hydrazine ingestion, or Gyromitra mushrooms (contains monomethylhydrazine precursors)

May be effective in ginkgo biloba seed toxicity

Dosage Forms & Strengths

injectable solution

  • 100mg/mL

tablets

  • 25mg
  • 50mg
  • 100mg
  • 200mg
  • 250mg
  • 500mg

tablets, sustained release

  • 500mg

Isoniazid (INH) Overdose

1 g per gram INH ingested or 70 mg/kg IV if unknown, may require 1 g q30min, not to exceed 5 g with unclear history

Prevention of Drug-Induced Neuritis

1-2 mg/kg/24 hr PO

Ethylene Glycol Toxicity

1-2 mg/kg IV during first 24 hr

Gyromitrin Poisoning

25 mg/kg IV infusion over 15-30 min, repeat PRN up to 15-20 g/day

Use in conjunction with benzodiazepines, phenobarbital

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Interactions

Interaction Checker

and pyridoxine (Antidote)

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)

              • cisplatin

                pyridoxine (Antidote) decreases effects of cisplatin by unknown mechanism. Contraindicated.

              Monitor Closely (8)

              • azithromycin

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

              • clarithromycin

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

              • erythromycin base

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

              • levodopa

                pyridoxine (Antidote) decreases levels of levodopa by increasing metabolism. Use Caution/Monitor. Interaction does not occur if carbidopa taken concurrently.

              • roxithromycin

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

              Minor (63)

              • amikacin

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

              • amiodarone

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

              • amoxicillin

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

              • aztreonam

                aztreonam will decrease the level or effect of pyridoxine (Antidote) 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 (Antidote) by altering metabolism. Minor/Significance Unknown.

              • cefadroxil

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

              • cefazolin

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

              • conjugated estrogens

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

              • conjugated estrogens, vaginal

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

              • dapsone

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

              • dicloxacillin

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

              • estradiol

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

              • estrogens conjugated synthetic

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

              • estrogens esterified

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

              • estropipate

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

              • ethotoin

                pyridoxine (Antidote) 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 (Antidote) 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 (Antidote) by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • fosphenytoin

                pyridoxine (Antidote) 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 (Antidote) 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 (Antidote) by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • hydralazine

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

              • isoniazid

                isoniazid decreases levels of pyridoxine (Antidote) 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 (Antidote) 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 (Antidote) 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 (Antidote) 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 (Antidote) by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • mestranol

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

              • metronidazole

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

              • penicillamine

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

              • phenobarbital

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

              • phenytoin

                pyridoxine (Antidote) 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 (Antidote) 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 (Antidote) 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 (Antidote) 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 (Antidote) 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 (Antidote) 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 (Antidote) 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 (Antidote) 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 (Antidote) 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 (Antidote) by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • theophylline

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

              • ticarcillin

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

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              Adverse Effects

              Frequency Not Defined

              Incoordination

              Headache

              Somnolence

              Increased AST

              Ataxia

              Neuropathy

              Paresthesia

              Seizures

              Death in large doses

              Delayed peripheral neurotoxicity long term

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              Pregnancy & Lactation

              Pregnancy Category: A

              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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              Pharmacology

              Mechanism of Action

              Shunts metabolism of ethylene glycol to nontoxic nonoxalates

              Helps replete GABA depleted by INH or monomethylhydrazine

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              Administration

              INH seizure: slow IV rate 0.5 g/min; remaining dose infused over 4-6 hr since seizure ceases to maintain pyridoxine avail. as INH metabolizes

              Gyromitra: infuse over 15-30 min

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              Formulary

              FormularyPatient Discounts

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              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.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each 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.