Published: 5 June 2025

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Vitamin B6 (pyridoxine) and peripheral neuropathy

Published: 5 June 2025
Prescriber Update 46(2): 29–30
June 2025

The New Zealand Pharmacovigilance database recently received a case report where the person experienced symptoms of peripheral neuropathy in association with a vitamin B6-containing dietary supplement (report ID 161190).

The Australian Therapeutic Goods Administration has also received a number of reports of peripheral neuropathy linked to vitamin B6 exposure and has taken regulatory action.¹

Vitamin B6

Vitamin B6 (pyridoxine) is a water-soluble vitamin found in food. It may also be an ingredient in dietary supplements and some medicines.¹

Vitamin B6 is commonly present in multivitamin and mineral preparations that are intended for purposes other than B vitamin supplementation, such as zinc and magnesium supplements.¹ Advise patients to check labels of any supplements they are taking.

The recommended daily intake of vitamin B6 ranges from 0.5 to 1.7 mg/day, depending on age and gender.²

Peripheral neuropathy

Peripheral neuropathy can be caused by genetic factors, infections, metabolic disorders, exposure to toxins and the presence of underlying medical conditions.³

Depending on the nerves affected, patients with peripheral neuropathy may present with a wide spectrum of symptoms, including paraesthesia (burning, tingling, pricking sensations), hyperaesthesia, weakness, atrophies, reduced or diminished reflexes and pain.³

Long-term use of high doses of vitamin B6 is associated with severe peripheral neuropathy.⁴ However, cases have also been reported in patients taking lower doses for a prolonged period.^1,3,5 Prescribers should be aware that vitamin B6 is contained in many different supplements and the patient may not be aware that they are taking it.^1,6

New Zealand case reports

From 1 January 2010 to 28 February 2025 there were six cases reported in New Zealand where the suspect medicine was a pyridoxine-containing product and the patient’s symptoms were suggestive of peripheral neuropathy (report IDs: 108875, 146625, 147097, 147746, 157407, 161190). In five of these reports, the suspect product was a dietary supplement that contained vitamin B6/pyridoxine.

Considerations for healthcare professionals

In patients presenting with signs and symptoms of peripheral neuropathy, consider vitamin B6 supplementation as a possible cause, and ask about dietary supplement use.

For information on the management of peripheral neuropathy, refer to local guidelines.

References

1. Therapeutic Goods Administration. 2022. Peripheral neuropathy with supplementary vitamin B6 (pyridoxine) 4 October 2022. URL: www.tga.gov.au/news/safety-updates/peripheral-neuropathy-supplementary-vitamin-b6-pyridoxine (accessed 28 April 2025).
2. National Health and Medical Research Council, Australian Government Department of Health and Ageing, New Zealand Ministry of Health. 2017. Nutrient Reference Values for Australia and New Zealand Including Recommended Dietary Intakes version 1.2 updated September 2017. URL: www.nhmrc.gov.au/about-us/publications/nutrient-reference-values-australia-and-new-zealand-including-recommended-dietary-intakes (accessed 10 April 2025).
3. Muhamad R, Akrivaki A, Papagiannopoulou G, et al. 2023. The role of vitamin B6 in peripheral neuropathy: a systematic review. Nutrients 15(13): 2823. DOI: 10.3390/nu15132823 (accessed 10 April 2025).
4. Multichem NZ Ltd. 2021. Pyridoxine Multichem New Zealand Data Sheet 11 November 2021. URL: www.medsafe.govt.nz/profs/Datasheet/a/Apopyridoxinetab.pdf (accessed 30 April 2025).
5. van Hunsel F, van de Koppel S, van Puijenbroek E, et al. 2018. Vitamin B6 in health supplements and neuropathy: case series assessment of spontaneously reported cases. Drug Safety 41(9): 859-69. DOI: 10.1007/s40264-018-0664-0 (accessed 14 April 2025).
6. Therapeutic Goods Administration. 2022. Health supplements containing vitamin B6 can cause peripheral neuropathy 10 November 2022. URL: www.tga.gov.au/news/safety-alerts/health-supplements-containing-vitamin-b6-can-cause-peripheral-neuropathy (accessed 8 May 2025).