Intended for healthcare professionals

Rapid response to:

Practice Rational Testing

Investigation of peripheral neuropathy

BMJ 2010; 341 doi: (Published 05 November 2010) Cite this as: BMJ 2010;341:c6100

Rapid Response:

Pyridoxine and Peripheral neuropathy

Hughes has given a good description of the agents causing and
investigations for peripheral neuropathy. However, I think there is a need
for increase in focus on treatment options for peripheral neuropathy.
Apart from few treatment options like use of pyridoxine to prevent
isoniazid induced peripheral neuropathy we still don't have a specific,
effective treatment for the same. Moreover, in a few situations like
oncology we have no options but to treat such patients despite troublesome
peripheral neuropathy. Thus, I feel we really need to find a solution for
this challenge so as to optimize benefits of a drug while reducing its
side effects.

Secondly, I do agree with Katie that pyridoxine is given for the
prevention of peripheral neuropathy. However, the effect of pyridoxine to
cause or prevent peripheral neuropathy depends upon the level of
pyridoxine in the body. Chronic administration of 1-6 g oral pyridoxine
per day for 12-40 months can cause severe and progressive sensory
neuropathy characterized by ataxia (loss of control of bodily movements).
The tolerable upper limit for vitamin B6 in adults, pregnancy and
lactation is 100mg. So it is double edge sword and we need to use it well.

1. Vitamin B6. Dietary Supplement fact Sheet. Office of Dietary
Supplements. National Institutes of Health. Available from Accessed on 29th September

Competing interests: I am a Medical Advisor in Pfizer India managing oncology portfolio

29 September 2011
Pratiksha J Kapse
Medical Advisor
Pfizer India