High-dose pyridoxine and peripheral neuropathy: Considerations for clinicians, pharmacists and policy-makers

Authors

  • B Job Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
  • M Govender Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
  • T N Gengiah Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa https://orcid.org/0000-0002-3405-5128

DOI:

https://doi.org/10.7196/SAMJ.2026.v116i5.4610

Keywords:

peripheral neuropathy; pyridoxine; isoniazid; tuberculosis, medicine scheduling; regulatory; SAHPRA, South Africa

Abstract

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References

1. Van der Watt JJ, Harrison TB, Benatar M, Heckmann JM. Polyneuropathy, anti-tuberculosis treatment and the role of pyridoxine in the HIV/AIDS era: A systematic review. Int J Tuberc Lung Dis 2011;15(6):722-728. https://doi.org/10.5588/ijtld.10.0284

2. National Department of Health, South Africa. National guidelines on the treatment of tuberculosis infection. Pretoria: NDoH, 2023.

3. Therapeutic Goods Administration, Australia. Health supplements containing vitamin B6 can cause peripheral neuropathy. Canberra: Australian Government Department of Health and Aged Care, 2022. https://www.tga.gov.au/news/safety-alerts/health-supplements-containing-vitamin-b6-can-cause- peripheral-neuropathy (accessed 19 May 2026).

4. Therapeutic Goods Administration, Australia. Safety advisory: Peripheral neuropathy from supplemental Vitamin B6 (pyridoxine). Canberra: Australian Department of Health, 2025. https://www. tga.gov.au/resources/publication/scheduling-decisions-interim/notice-interim-decision-proposed- amendments-poisons-standard-relation-pyridoxine-pyridoxal-or-pyridoxamine-vitamin-b6-acms-46- november-2024 (accessed 1 September 2025).

5. Therapeutic Goods Administration, Australia. Vitamin B6 (pyridoxine): Safety advisory – potential for dose-related adverse events. Canberra: Australian Department of Health, 2020. https://www.tga.gov.au/ safety/safety-monitoring-and-information/safety-alerts/vitamin-b6-pyridoxine (accessed 19 May 2026).

6. Turck D, Bohn T, Castenmiller J, et al. Scientific opinion on the tolerable upper intake level for vitamin B6. EFSA J 2023;21(5):e08006. https://doi.org/10.2903/j.efsa.2023.8006

7. Van Hunsel F, van de Koppel S, van Puijenbroek E, Kant A. Vitamin B6 in health supplements and neuropathy: Case series assessment of spontaneously reported cases. Drug Saf 2018;41(9):859-869. https://doi.org/10.1007/s40264-018-0664-0

8. NisarM,WatkinSW,BucknallRC,AgnewRA.Exacerbationofisoniazidinducedperipheralneuropathy by pyridoxine. Thorax 1990;45(5):419-420. https://doi.org/10.1136/thx.45.5.419

9. Therapeutic Goods Administration, Australia. Some dosages to be rescheduled as Pharmacist Only Medicines. Canberra: Australian Department of Health, 2026. https://www.tga.gov.au/news/ safety-updates/medicines-containing-vitamin-b6-pyridoxine-pyridoxal-or-pyridoxamine (accessed 19 Feb 2026).

10. Bhargava M, Bhargava A. Pyridoxine for patients suffering from drug-susceptible tuberculosis in India. Pub Health Act 2018;8(2):97. https://doi.org/10.5588/pha.18.0017

11. Hadtstein F, Vrolijk M. Vitamin B-6-induced neuropathy: Exploring the mechanisms of pyridoxine toxicity. Adv Nutr 2021;12(5):1911-1929. https://doi.org/10.1093/advances/nmab033

12. Procter & Gamble Company and affiliates. NEUROBION tablets with Vitamin B1, B6 and B12. The Procter & Gamble Company and affiliates, 2026. https://www.neurobion.com/en-za/neurobion (accessed 19 May 2026).

13. Court R, Centner CM, Chirehwa M, et al. Neuropsychiatric toxicity and cycloserine concentrations during treatment for multidrug-resistant tuberculosis. Int J Infect Dis 2021;105:688-694. https://doi. org/10.1016/j.ijid.2021.03.001

14. National Department of Health, South Africa. Medicines and Related Substances Act, No. 101 of 1965. Consolidated schedules. Pretoria: NDoH, 2025. https://www.sahpra.org.za/wp-content/uploads/2025/08/ Consolidated-Schedules_01-August-2025.pdf (accessed 1 September 2025).

15. Muhamad R, Akrivaki A, Papagiannopoulou G, Zavridis P, Zis P. The role of vitamin B6 in peripheral neuropathy: A systematic review. Nutrients 2023;15(13):2823. https://doi.org/10.3390/nu15132823

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Published

2026-06-02

Issue

Section

Editorials

How to Cite

1.
Job B, Govender M, Gengiah TN. High-dose pyridoxine and peripheral neuropathy: Considerations for clinicians, pharmacists and policy-makers. S Afr Med J [Internet]. 2026 Jun. 2 [cited 2026 Jun. 3];116(5):e4610. Available from: https://www.samajournals.co.za/index.php/samj/article/view/4610

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