Expert Consensus on Vitamin B6 Therapeutic Use for Patients: Guidance on Safe Dosage, Duration and Clinical Management

Natalie Schellack,1 Kitiyot Yotsombut,2 Arman Sabet,3 Jalal Nafach,4 Fu Liong Hiew,5 Kongkiat Kulkantrakorn6 1Department of Pharmacology, University of Pretoria, Pretoria, Gauteng, South Africa; 2Department of Pharmacy Practice, Chulalongkorn University, Bangkok, Thailand; 3School of Medicine, Griffith University, Gold Coast, Queensland, Australia; 4Department of Diabetes, Dubai Health Diabetes Center, Dubai, United Arab Emirates; 5Department of Medicine, Sunway Medical Centre, Subang Jaya, Selangor, Malaysia; 6Department of Internal Medicine, Thammasat University, Pathum Thani, ThailandCorrespondence: Kongkiat Kulkantrakorn, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand, Email [email protected]: Vitamin B6 is a crucial water-soluble vitamin found in many foods and is involved in numerous physiological processes, including neurotransmitter synthesis and nervous system function. Although essential for overall health, both deficiency and excessive intake of vitamin B6 may lead to health complications, particularly peripheral neuropathy. This consensus statement aims to provide healthcare professionals with clear guidance on the safe and effective use of vitamin B6, focusing on its benefits, risks, recommended dosages, and treatment course.Methods: This consensus statement was developed using a Delphi approach involving a panel of six experts from various medical specialties. This process includes a comprehensive literature review, two rounds of anonymous online surveys, and a virtual expert roundtable discussion. The GRADE approach was used to assess the quality of evidence for each recommendation.Results: The expert panel reached consensus on five key statements. These key recommendations encompass the function of vitamin B6, complications due to vitamin B6 deficiency, dosage recommendations, adverse events, and monitoring guidance throughout the course of treatment. A washout period of 20– 40 days for the complete clearance of vitamin B6 was calculated based on pharmacokinetic parameters. A clinical pathway for managing patients who might benefit from vitamin B6 treatment was proposed.Conclusion: This consensus statement highlights the importance of recognizing the benefits and potential risks of vitamin B6. While the therapeutic dosage of vitamin B6 can be beneficial to treat deficiency, excessive intake can lead to adverse effects. This statement emphasizes the need for individualized patient care considering factors such as medical history, lifestyle, and potential drug interactions. Further research is needed to establish clearer dosage guidelines, understand the mechanisms of vitamin B6-induced neurological side effects, and optimize patient outcomes.Keywords: vitamin B6, pyridoxine, safety, clinical guidance, consensus statement, neuropathy