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      News & Perspective Drugs & Diseases CME & Education Video Decision Point
      Drugs & Diseases

      pyridoxine (Antidote) (Rx)

      Brand and Other Names:vitamin B6 (Antidote)
      • Print

      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

      Next:

      Interactions

      Interaction Checker

      + pyridoxine (Antidote)

      No Results

         activity indicator 
        No Interactions Found
        Interactions Found

        Contraindicated

          Serious

            Significant - Monitor Closely

              Minor

                All Interactions Sort By:
                 activity indicator 

                Contraindicated (0)

                  Serious (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 (61)

                  • 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.

                  • 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.

                  • 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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                  Images

                  No images available for this drug.
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                  Patient Handout

                  A Patient Handout is not currently available for this monograph.
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                  Formulary

                  FormularyPatient Discounts

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                  The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

                  View explanations for tiers and restrictions
                  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.
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