Parenteral Manual

Pyridoxine HCl

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Vitamin B6
Classification: 
Vitamin, Antidote
Original Date: 
August 2005
Revised Date: 
December 2019
Indications: 
  • Prevent and treat vitamin B6 deficiency
  • Treatment of pyridoxine dependent seizures
  • Treatment of drug-induced deficiency
  • Treatment of isoniazid overdose
  • Treatment of mushroom (genus Gyromitra) poisoning
Reconstitution and Stability: 
  • Protect from light
  • Stable at room temperature
  • Diluted solutions stable 24 hours at room temperature                                                            
Compatibility: 

- Solutions Compatible: D5W, saline solutions, ringer's lactate

- Additive/above cassette Compatible: no information

- Y-site Compatible: no information

Incompatible: alkaline solutions (eg. sodium bicarbonate), iron salts and oxidizing agents

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM YES
IV Direct

YES
Usual dilution: undiluted
Infusion rate: do not exceed 50 mg/minute

Infusion rate for Isoniazid Overdose: MAX rate of 500 mg/min. When seizures stop infuse over 4 hours
IV Intermittent Infusion

YES
Usual dilution: 50 mg/mL
Infusion rate: do not exceed 50 mg/minute

Infusion rate for Isoniazid Overdose: MAX rate of 500 mg/min. When seizures stop infuse over 4 hours.

Infusion rate for mushroom poisoning: over 15 - 30 min
IV Continuous Infusion NO
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pyridoxine-dependant seizures:

  • 10-100 mg IM/IV    

Isoniazid overdose:   

  • Pyridoxine 70 mg/kg/dose (MAX 5 g/dose) IV over 10 minutes. If seizures stop before 10 minutes, the remainder of the loading dose should be given over 4 hours. May repeat x1, if seizures persist or recur.
  • Pyridoxine can also be dosed as 1 gram per gram of isoniazid ingested. (ie if 20 g of isoniazid ingested, 20 g of pyridoxine is given)

Mushroom poisoning:

  • 25 mg/kg IV over 15-30 minutes; repeat PRN if seizures persist or recur despite benzodiazepine therapy to a max total daily dose of 15-20 g

Ethylene glycol poisoning:

50 mg IV every 6 hours until ethylene glycol and glycolic acid levels are undetectable. Alternative dosing is 100 mg IV daily.

Potential hazards of parenteral administration: 
  • Some slight flushing or feeling of warmth may occur                                             
  • Low folic acid levels, paresthesias 
  • Large doses may cause anaphylactic reactions
  • Seizures                                                                                    
  • Burning or stinging at injection site
  • Elevated AST
Notes: 
  • May be indicated rarely in treatment of isoniazid and alcoholic neuritis                             
  • Monitor respiratory rate, heart rate and blood pressure with IV use 

The information contained on this website is provided for informational purposes only, as a guide to assist physicians, nurses and other healthcare providers in deciding on the appropriate care required for a particular patient. At all times, physicians, nurses and other healthcare providers must exercise their independent clinical judgment, based on their knowledge, training and experience, taking into account the specific facts and circumstances of each patient, when deciding on the appropriate course of investigation and/or treatment to recommend in a particular clinical situation.

CHEO has made every effort to ensure that the information contained on this website is as current and accurate as possible. However, changes can occur due to ongoing research and the constant influx of new information. Where possible, hospitals and healthcare practitioners should verify the information before acting on it.

Reliance on any information in this website is at the user's own risk. CHEO is not responsible or liable for any harm, loss or other consequences from the use or misuse of the information on this website.