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Poisoning Information for the Public & Health Care Professionals

Atlantic Canada Poison Centre
Antidote Kit Manual

1-800-565-8161 or 902-470-8161 | atlanticcanadapoisoncentre.ca
Last updated: 08/2019
Pediatric Adult
Last updated: 08/2019
Antidote
Pediatric

Pyridoxine

Vitamin B6

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Antidote
Pediatric

Pyridoxine

Vitamin B6

Indications

  • Management of seizures/altered mental status (in conjunction with benzodiazepines) associated with isoniazid, hydrazines or gyromitra mushrooms toxicity.
  • Adjunctive therapy for ethylene glycol toxicity.

Dosage

If the IV formulation is not available, pyridoxine can be given orally.  Since pyridoxine is water soluble, dosing precision using tablets is not critical.  

ISONIAZID OVERDOSE:

  • Oral via NG: 70 mg/kg (Maximum single dose: 5 g)
  • IV: 70 mg/kg IV over 10 minutes (Maximum single dose: 5 g).  If the seizures stop before 10 minutes, the remainder of the loading dose should be given over 4 hours.
  • May repeat dose once, if seizures persist or recur. 

HYDRAZINE/ GYROMITRA MUSHROOM POISONING:

  • Oral via NG: 25 mg/kg (Maximum single dose: 5 g)
  • IV: 25 mg/kg IV over 30 - 60 minutes (Maximum single dose: 5 g)  
  • May repeat dose if seizures persist or recur. 

ETHYLENE GLYCOL TOXICITY:

50mg (IV direct or oral) every 6 hours until ethylene glycol and glycolic acid levels are undetectable. If using oral route, tablets can be split and approximate dose of 50 to 100mg can be given. 

Administration

  • IV Direct: Administer undiluted (100 mg/mL): Dose and rate varies according to Indication. See dosage section for details.
  • Infusion: There is little published information on the administration of pyridoxine via infusion, especially for the pediatric population.
    • Prepare a final concentration of 50 mg/mL solution: Add 2500 mg (25 mL 0f 100 mg/mL pyridoxine solution) to 25 mL sodium chloride 0.9% for a final volume of 50 mL. Maximum rate: 1 g/minute.
    • Protect pyridoxine infusion from light.
  • Oral: Doses can be given orally, as a slurry via NG tube.  

Compatibility, Stability

  • Compatible in sodium chloride 0.9% dextrose 5% in water or dextrose-saline combinations.
  • Protect injection and infusions from light.

Potential Hazards of Administration

  • Nausea, headache, flushing, feeling of warmth may occur.
  • Large doses may cause anaphylactic reactions or seizures.
  • Decreased serum folic acid concentrations, increased AST.
  • When administering large IV doses, heart rate, respiratory rate and blood pressure monitoring are recommended.

Bailey, B., Blais, R., Gaudreault, P., Gosselin, S., & Laliberte, M. (2009). Antidotes en toxicologie d'urgence (3rd ed.). Quebec, Canada: Centre antipoison du Quebec.

Borron, S. W., Bronstein, A. C., Fernandez, M. C., & et all. (2014). Walter F. G. (Ed.), AHLS advanced hazmat life support, provider manual (4th ed.). Tucson, Arizona: The University of Arizona College of Medicine.

Burda, A. M., Sigg, T., Haque, D., & Bardsley, C. H. (2007). Inadequate pyridoxine stock and its effect on patient outcome. American Journal of Therapeutics, 14, 262-264.

Goldfrank, L. R., Nelson, L. S., Lewin, N. A., Howland, M. A., Hoffman, R. S., (2015). Goldfrank's toxicologic emergencies(Tenth ed.). New York: McGraw Hill.

IWK Regional Poison Centre. (2013). Toxic alcohols (methanol and ethylene glycol): A brief overview for emergency departments. Unpublished manuscript.

Micromedex, T. H. A. (2014). Micromedex health care systems. Retrieved from http://www.micromedexsolutions.com

Olson, K. R. (2007). Poisoning & drug overdose (Sixth ed.). New York: McGraw Hill.

Shannon, M. W., Borron, S. W., & Burns, M. J. (2007). Haddad and Winchester's clinical management of poisoning and drug overdose (Fourth ed.). Philadelphia: Saunders Elsevier.