Pyridoxine in clinical toxicology: a review

Eur J Emerg Med. 2005 Apr;12(2):78-85. doi: 10.1097/00063110-200504000-00007.


Pyridoxine (vitamin B6) is a co-factor in many enzymatic pathways involved in amino acid metabolism: the main biologically active form is pyridoxal 5-phosphate. Pyridoxine has been used as an antidote in acute intoxications, including isoniazid overdose, Gyromitra mushroom or false morrel (monomethylhydrazine) poisoning and hydrazine exposure. It is also recommended as a co-factor to improve the conversion of glyoxylic acid into glycine in ethylene glycol poisoning. Other indications are recommended by some sources (for example crimidine poisoning, zipeprol and theophylline-induced seizures, adjunct to d-penicillamine chelation), without significant supporting data. The value of pyridoxine or its congener metadoxine as an agent for hastening ethanol metabolism or improving vigilance in acute alcohol intoxication is controversial. This paper reviews the various indications of pyridoxine in clinical toxicology and the supporting literature. The potential adverse effects of excessive pyridoxine dosage will also be summarized.

Publication types

  • Review

MeSH terms

  • Animals
  • Antidotes / therapeutic use*
  • Ethanol / poisoning
  • Ethylene Glycol / poisoning
  • Humans
  • Hydrazines / poisoning
  • Isoniazid / poisoning
  • Mushroom Poisoning / drug therapy
  • Poisoning / drug therapy*
  • Pyridoxine / therapeutic use*
  • Pyrimidines / poisoning


  • Antidotes
  • Hydrazines
  • Pyrimidines
  • hydrazine
  • Ethanol
  • Ethylene Glycol
  • Pyridoxine
  • Isoniazid
  • crimidine