Neuropathie périphérique avec hypervitaminose B6 provoquée par l’automédication

Malet, L.; Dayot, L.; Moussy, M.; Gastine, B. de la; Goutelle, Sylvain

doi:10.1016/j.revmed.2019.11.003

Cited by 6 publications

(5 citation statements)

References 22 publications

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“…In the supplemented group, more than three-quarters of patients had above-normal PLP levels, but we did not find any neurological manifestation that could be attributed to vitamin B 6 overdose; however, patients were assessed only by clinical neurological examination without a dedicated electrophysiology study. Multiple publications have described a link between the occurrence of peripheral neuropathy and vitamin B 6 overdose 20. In most published cases, this complication appears with large doses of vitamin B 6 (2–6 g/d)21; but also with 50–600 mg/day dosages over several months to several years 20…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“… 20 In most published cases, this complication appears with large doses of vitamin B 6 (2–6 g/d) 21 ; but also with 50–600 mg/day dosages over several months to several years. 20 …”

Section: Discussionmentioning

confidence: 99%

“…Multiple publications have described a link between the occurrence of peripheral neuropathy and vitamin B 6 overdose. 20 In most published cases, this complication appears with large doses of vitamin B 6 (2-6 g/d) 21 ; but also with 50-600 mg/day dosages over several months to several years. 20 All the patients included in this study received DP for a relatively long time, about 4 years on average, so these results should not be extrapolated to patients in the initial phases of treatment.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of vitamin B₆supplementation in Wilson’s disease patients treated with D-penicillamine

Mbala,

Belmalih,

Guillaud

et al. 2023

BMJ Open Gastroenterol

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IntroductionWilson’s disease (WD) is a copper metabolism disorder characterised by a progressive accumulation of this metal mainly in the liver and the brain. Treatment is based on the removal of copper operated by the chelators, among which, D-penicillamine (DP) is prescribed as a first-line treatment in most situations. There is some evidence in linking the use of DP with a risk of vitamin B6; therefore, vitamin supplementation is sometimes recommended, although non-consensually. The objective of our study was to evaluate the level of vitamin B6in WD patients treated with DP with and without associated supplementation.MethodologyAll WD patients followed at the National Reference Centre for WD in Lyon between January 2019 and December 2020 treated with DP for more than 1 year were included and separated in two groups according to vitamin B6supplementation. The level of vitamin B6was measured by the determination of pyridoxal phosphate (PLP).ResultsA total of 37 patients were included. Average age of 23.3±14.8 years, 15 patients with <18 years. Median duration of treatment was 51 (55.8) months. 15 patients were under vitamin B6supplementation and 22 had interrupted it for more than 1 year. The median PLP level was significantly higher in the group with supplementation, 137.2 (86.7) nmol/L vs 64.9 (30.8) nmol/(p<0.01). No patient had a PLP level<35 nmol/L.ConclusionLong-term stable WD patients under DP treatment probably do not need vitamin B6supplementation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“… 20 In most published cases, this complication appears with large doses of vitamin B 6 (2–6 g/d) 21 ; but also with 50–600 mg/day dosages over several months to several years. 20 …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Evaluation of vitamin B₆supplementation in Wilson’s disease patients treated with D-penicillamine

Mbala,

Belmalih,

Guillaud

et al. 2023

BMJ Open Gastroenterol

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“…Although US guidelines approve up to 100 mg per day of B6 as a safe dose to avoid neurotoxicity, there are several reported cases of pyridoxine-induced neuropathy from using low doses (25–50 mg/d) for longer than 6 months. 18 European guidelines currently recommend a maximum dose of 25 mg B6 per day.…”

Section: Vitamin B6 Toxicitymentioning

confidence: 99%

Preventing Vitamin B6–Related Neurotoxicity

Reddy¹

2021

American Journal of Therapeutics

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Background: Vitamin B6 is essential for life and plays a critical role in many biochemical and physiological processes in the human body. The term B6 collectively refers to 6 water-soluble vitamers, and only the pyridoxal 59-phosphate (PLP) serves as the biologically active form. A plasma PLP concentration above 30 nmol/L (7.4 mg/L) is indicative of an adequate vitamin B6 status for all age and sex groups. The currently recommended daily allowance of B6 (1.5-2 mg/d) from dietary sources frequently results in inadequate B6 status (,20 nmol/L or 5 mg/L) in many elderly patients and patients with comorbid conditions. PLP-based supplements are preferred and should be administered weekly in low doses (50-100 mg) to maintain a stable serum PLP level between 30 and 60 nmol/L or 7.4 and 15 mg/L. Areas of Uncertainty:It is challenging for physicians to prescribe a safe dose of B6 supplements because of the narrow therapeutic index. The association between elevated levels of pyridoxine and neuropathy is not well established. PLP-based supplements are shown to be least neurotoxic, but further clinical trials are needed to establish the long-term safety in high doses.Data Sources: PubMed search of randomized control trials and meta-analyses.Therapeutic Opinion: Plasma B6 levels should be ordered as a part of workup of any unexplained anemia before labeling as "anemia of chronic disease." B6 supplementation is also crucial in the management of chronic Mg deficiency resistant to therapy. When B6 is administered daily in supraphysiologic doses, there is a potential for the development of neurotoxicity (typically at levels .100 nmol/L or 25 mg/L). PLP-based supplements are preferred over pyridoxine supplements because of minimal neurotoxicity observed in neuronal cell viability tests. Since B6 metabolites have a long half-life, weekly administration is preferred over daily use to prevent toxicity.

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Neuropathie périphérique avec hypervitaminose B6 provoquée par l’automédication

Cited by 6 publications

References 22 publications

Evaluation of vitamin B₆supplementation in Wilson’s disease patients treated with D-penicillamine

Evaluation of vitamin B₆supplementation in Wilson’s disease patients treated with D-penicillamine

Preventing Vitamin B6–Related Neurotoxicity

PCR-7060 overdose

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Neuropathie périphérique avec hypervitaminose B6 provoquée par l’automédication

Cited by 6 publications

References 22 publications

Evaluation of vitamin B6supplementation in Wilson’s disease patients treated with D-penicillamine

Evaluation of vitamin B6supplementation in Wilson’s disease patients treated with D-penicillamine

Preventing Vitamin B6–Related Neurotoxicity

PCR-7060 overdose

Contact Info

Product

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Evaluation of vitamin B₆supplementation in Wilson’s disease patients treated with D-penicillamine

Evaluation of vitamin B₆supplementation in Wilson’s disease patients treated with D-penicillamine