Vitamin <scp>B6:</scp> too much, too little, too late? An analysis of sales trends in Australia from 2023 to 2025

BACKGROUND: Peripheral neuropathy associated with vitamin B6 (pyridoxine) is dose and duration dependent. High-dose vitamin B6 products associated with adverse neurological effects are available in Australia, prompting recent regulatory action to reschedule products containing ≥50 mg pyridoxine to schedule 3 (pharmacist only). AIMS: This study examined real-world consumer purchasing behaviours of vitamin B6 products in Australian pharmacies to identify high-risk purchasing patterns (e.g. large doses, multiple products, stockpiling behaviours). METHODS: Sales data from the IQVIA Consumer Health Basket Database (1 August 2022-31 July 2025), representing ~75% of national pharmacy-based complementary medicines sales were analysed. Listed medicines on the Australian Register of Therapeutic Goods providing a daily dose of ≥5 mg total equivalent pyridoxine were included (n = 792). Analysis included unit sales, combined total maximum daily dosage per transaction and duplicate purchases as a proxy for ongoing use. RESULTS: A total of 20.32 million products (≥5 mg) were sold across 15.8 million transactions. Products containing 10-49 mg dominated sales with 11.0 million (54.20%) unit sales, and ≥50 mg doses accounted for 3.40 million (16.75%) units and 3.4 million (21.63%) of all transactions. Multiple products or duplicate purchases occurred in 1.2 million (7.73%) and 1.58 million (9.17%) transactions respectively. Sales were otherwise stable, except for the 2023 withdrawal of >100 mg products. CONCLUSION: Large volumes of vitamin B6 products containing doses above the recommended intake continue to be purchased in Australia, including through combinations of lower-dose products that will not be affected by proposed rescheduling. The implementation period for scheduling extends the potential for stockpiling, meaning that high-risk exposure will persist without strengthened risk communication.