Vitamin B6 includes a group of closely related compounds: pyridoxine, pyridoxal, and pyridoxamine. They are metabolized in the body to pyridoxal phosphate, which acts as a coenzyme in many important reactions in blood, central nervous system, and skin metabolism. Vitamin B6 is important in heme and nucleic acid biosynthesis and in lipid, carbohydrate, and amino acid metabolism (see table ).
Dietary sources of vitamin B6 include organ meats (eg, liver), whole-grain cereals, fish, and legumes. (See also Overview of Vitamins Overview of Vitamins Vitamins may be Fat soluble (vitamins A, D, E, and K) Water soluble (B vitamins and vitamin C) The B vitamins include biotin, folate, niacin, pantothenic acid, riboflavin (B2), thiamin (B1)... read more .)
Etiology of Vitamin B6 Deficiency and Dependency
Dietary vitamin B6 deficiency, though rare, can develop because extensive processing can deplete foods of vitamin B6.
Secondary vitamin B6 deficiency most often results from
Use of pyridoxine-inactivating drugs (eg, antiseizure drugs, isoniazid, cycloserine, hydralazine, corticosteroids, penicillamine)
Rarely, secondary deficiency results from increased metabolic demand (eg, in hyperthyroidism Hyperthyroidism Hyperthyroidism is characterized by hypermetabolism and elevated serum levels of free thyroid hormones. Symptoms include palpitations, fatigue, weight loss, heat intolerance, anxiety, and tremor... read more ).
Rare inborn errors of metabolism Introduction to Inherited Disorders of Metabolism Most inherited disorders of metabolism (also called inborn errors of metabolism) are caused by mutations in genes that code for enzymes; enzyme deficiency or inactivity leads to Accumulation... read more can affect pyridoxine metabolism.
Symptoms and Signs of Vitamin B6 Deficiency and Dependency
Vitamin B6 deficiency causes peripheral neuropathy and a pellagra-like syndrome, with seborrheic dermatitis, glossitis, and cheilosis, and, in adults, can cause confusion, electroencephalogram abnormalities, and seizures. Any relationship between pyridoxine and anxiety or depression is uncertain.
Rarely, deficiency or dependency causes seizures in infants. Seizures, particularly in infants, may be refractory to treatment with antiseizure drugs.
Normocytic, microcytic, or sideroblastic anemia can also develop.
Diagnosis of Vitamin B6 Deficiency and Dependency
Vitamin B6 deficiency should be considered in
Any infant who has seizures
Any patient who has seizures refractory to treatment with antiseizure drugs
Any patient with deficiencies of other B vitamins, particularly in patients with alcohol use disorder Alcohol Use Disorder and Rehabilitation Alcohol use disorder involves a pattern of alcohol use that typically includes craving and manifestations of tolerance and/or withdrawal along with adverse psychosocial consequences. Alcoholism... read more or protein-energy undernutrition Protein-Energy Undernutrition (PEU) Protein-energy undernutrition (PEU), previously called protein-energy malnutrition, is an energy deficit due to deficiency of all macronutrients. It commonly includes deficiencies of many micronutrients... read more
Diagnosis of vitamin B6 deficiency is usually clinical. There is no single accepted laboratory test of vitamin B6 status; measurement of serum pyridoxal phosphate is most common.
Pearls & Pitfalls
Treatment of Vitamin B6 Deficiency and Dependency
Elimination of risk factors when possible
For secondary vitamin B6 deficiency, causes (eg, use of pyridoxine-inactivating drugs, malabsorption) should be corrected if possible.
Usually, pyridoxine 50 to 100 mg orally once a day corrects the deficiency in adults. Most people taking isoniazid should also be given pyridoxine 30 to 50 mg orally once a day. For deficiency due to increased metabolic demand, amounts larger than the daily recommended intake may be required. For most cases of inborn errors of metabolism, high doses of pyridoxine may be effective.
Vitamin B6 deficiency is usually caused by pyridoxine-inactivating drugs (eg, isoniazid), protein-energy undernutrition, malabsorption, alcohol use disorder, or excessive loss.
Deficiency can cause peripheral neuropathy, seborrheic dermatitis, glossitis, and cheilosis, and, in adults, confusion and seizures.
Suspect and diagnose based on clinical findings.
Correct secondary causes, or give supplemental pyridoxine.