Last update: May 22, 2019

Vitamin B6

Very Low Risk for breastfeeding


Safe. Compatible.
Not risky for breastfeeding or infant.

The approved indications for vitamin B6 are exclusively related to vitamin B6 deficiency due to inadequate diet, drug-induced deficiency, such as isoniazid (INH) and oral contraceptives, and due to inborn errors of metabolism, such as seizures or vitamin B6-dependent anemia.
Off-label indications to treat neuropathies and radicular, back, sciatic and carpal tunnel pain (Geller 2016, Mibielli 2009) lack sufficient scientific evidence (Ang 2008, O'Connor 2003).

Daily requirements of Vitamin B6 are between 2 to 3 mg per day (Sauberan 2019, Ares 2015, Hall 2010, Chang 2002, Bender 1989). With a varied and balanced diet you do not need supplements containing this vitamin. Its deficiency is very rare because it is widely found in food.

Excessive doses (more than 50-100 mg/day) and doses taken over prolonged periods (months versus years), such as those used in off-label indications, can cause neuropathies and other neurological problems in people who take them (van Hunsel 2018 , ADRAC 2008, Bender 1989, Waterston 1987, Dalton 1987, Schaumburg 1983).

Vitamin B6 is found in breastmilk at a concentration of between 0.005 to 0.25 mg/L (Sauberan 2019, Hampel 2017, Lawrence 2016 p299, Ren 2015, Roepke 1979) and is higher in mature milk (0.1 to 0.25 mg/L ) than in transitional milk and in colostrum (0.01 to 0.02 mg/L).

The concentration of vitamin B6 in breastmilk increases with supplements in the diet or from treatments with Vitamin B6 (Sauberan 2019, Hampel 2017, Chang 2002, Ooylan 2002, Chang 1990, Styslinger 1985, Thomas 1980 and 1979, Roepke1979, West 1976).
The high plasma protein binding of vitamin B6 hinders excretion in breastmilk, so it is very unlikely that supplementation will reach therapeutic levels that may affect the infant (milk levels would need to be 200 times higher than usual).
Problems have never been reported in infants breastfed by mothers taking Vitamin B6.

If supplements are needed due to deficiency or inadequate diet, it is not advisable to exceed 40-100 mg daily during breastfeeding (Sauberan 2019, van Hunsel 2018, Hale 2017 p.817, Ares 2015).

There is insufficient evidence and contradictory reports on the ability of pyridoxine in high doses to inhibit prolactin secretion and nullify milk production (AlSaad 2017, Anderson 2017, Oladapo 2012, Pepperell 1986, Andon 1985, Scaglione 1982, Vecchione 1980, Greentree 1979, de Waal 1978, Lehtovirta 1978, Macdonald 1976, Canales 1976, McIntosh 1976, Marcus 1975, Foukas 1973).
Milk production shoud therefore be monitored if Vitamin B6 is administered at higher doses than required daily.

Various medical associations, experts and expert consensus consider the use of this medication to be safe during breastfeeding (Hale 2017 p 817, Briggs 2017).
American Academy of Pediatrics: medication usually compatible with breastfeeding (AAP 2001).
List of essential medicines WHO: compatible with breastfeeding (WHO 2002).

Alternatives

We do not have alternatives for Vitamin B6 since it is relatively safe.

Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Group

Vitamin B6 belongs to this group or family:

Tradenames

Main tradenames from several countries containing Vitamin B6 in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 100 %
Molecular weight 206 - 298 daltons
Protein Binding 100 %
Tmax 1 - 2 hours
T1/2 360 - 480 hours
Theoretical Dose 0,02 - 0,05 mg/Kg/d
Relative Dose 67 - 100 %

References

  1. Sauberan JB. High-Dose Vitamins. Breastfeed Med. 2019 Apr 30. Abstract
  2. van Hunsel F, van de Koppel S, van Puijenbroek E, Kant A. Vitamin B(6) in Health Supplements and Neuropathy: Case Series Assessment of Spontaneously Reported Cases. Drug Saf. 2018 Abstract
  3. Hale TW, Rowe HE. Medications & Mothers' Milk. A Manual of Lactation Pharmacology. Springer Publishing Company. 2017
  4. Hampel D, Shahab-Ferdows S, Islam MM, Peerson JM, Allen LH. Vitamin Concentrations in Human Milk Vary with Time within Feed, Circadian Rhythm, and Single-Dose Supplementation. J Nutr. 2017 Abstract
  5. AlSaad D, Awaisu A, Elsalem S, Abdulrouf PV, Thomas B, AlHail M. Is pyridoxine effective and safe for post-partum lactation inhibition? A systematic review. J Clin Pharm Ther. 2017 Abstract
  6. Anderson PO. Drugs that Suppress Lactation, Part 2. Breastfeed Med. 2017 Abstract
  7. Briggs GG, Freeman RK, Towers CV, Forinash AB. Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk. Wolters Kluwer Health. 11th edition (acces on line) 2017
  8. Geller M, Mibielli MA, Nunes CP, da Fonseca AS, Goldberg SW, Oliveira L. Comparison of the action of diclofenac alone versus diclofenac plus B vitamins on mobility in patients with low back pain. J Drug Assess. 2016 Abstract
  9. Ares Segura S, Arena Ansótegui J, Díaz-Gómez NM; en representación del Comité de Lactancia Materna de la Asociación Española de Pediatría. La importancia de la nutrición materna durante la lactancia, ¿necesitan las madres lactantes suplementos nutricionales? [The importance of maternal nutrition during breastfeeding: Do breastfeeding mothers need nutritional supplements?] An Pediatr (Barc). 2015 Abstract Full text (link to original source) Full text (in our servers)
  10. Hampel D, Allen LH. Analyzing B-Vitamins in Human Milk: Methodological Approaches. Crit Rev Food Sci Nutr. 2015 Abstract
  11. Ren X, Yang Z, Shao B, Yin SA, Yang X. B-Vitamin Levels in Human Milk among Different Lactation Stages and Areas in China. PLoS One. 2015 Abstract Full text (link to original source) Full text (in our servers)
  12. Oladapo OT, Fawole B. Treatments for suppression of lactation. Cochrane Database Syst Rev. 2012 Abstract
  13. Hall Moran V, Lowe N, Crossland N, Berti C, Cetin I, Hermoso M, Koletzko B, Dykes F. Nutritional requirements during lactation. Towards European alignment of reference values: the EURRECA network. Matern Child Nutr. 2010 Oct;6 Suppl 2:39-54. Abstract Full text (link to original source) Full text (in our servers)
  14. Mibielli MA, Geller M, Cohen JC, Goldberg SG, Cohen MT, Nunes CP, Oliveira LB, da Fonseca AS. Diclofenac plus B vitamins versus diclofenac monotherapy in lumbago: the DOLOR study. Curr Med Res Opin. 2009 Abstract
  15. ADRAC. Adverse Drug Reactions Advisory Committee. High-dose vitamin B6 may cause peripheral neuropathy. Aust Adverse Drug React Bull 2008; 27: 14–15. 2008 Full text (link to original source) Full text (in our servers)
  16. Ang CD, Alviar MJ, Dans AL, Bautista-Velez GG, Villaruz-Sulit MV, Tan JJ, Co HU, Bautista MR, Roxas AA. Vitamin B for treating peripheral neuropathy. Cochrane Database Syst Rev. 2008 Abstract
  17. O'Connor D, Marshall S, Massy-Westropp N. Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database Syst Rev. 2003 Abstract
  18. WHO / UNICEF. BREASTFEEDING AND MATERNAL MEDICATION Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs. Department of Child and Adolescent Health and Development (WHO/UNICEF) 2002 Full text (link to original source) Full text (in our servers)
  19. Ooylan LM, Hart S, Porter KB, Driskell JA. Vitamin B-6 content of breast milk and neonatal behavioral functioning. J Am Diet Assoc. 2002 Abstract
  20. Chang SJ, Kirksey A. Vitamin B6 status of breast-fed infants in relation to pyridoxine HCl supplementation of mothers. J Nutr Sci Vitaminol (Tokyo). 2002 Abstract
  21. AAP - American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001 Sep;108(3):776-89. Abstract Full text (link to original source) Full text (in our servers)
  22. Chang SJ, Kirksey A. Pyridoxine supplementation of lactating mothers: relation to maternal nutrition status and vitamin B-6 concentrations in milk. Am J Clin Nutr. 1990 Abstract
  23. Gupta T, Sharma R. An antilactogenic effect of pyridoxine. J Indian Med Assoc. 1990 Abstract
  24. Bender DA. Vitamin B6 requirements and recommendations. Eur J Clin Nutr. 1989 Abstract
  25. Dalton K, Dalton MJ. Characteristics of pyridoxine overdose neuropathy syndrome. Acta Neurol Scand. 1987 Abstract
  26. Waterston JA, Gilligan BS. Pyridoxine neuropathy. Med J Aust. 1987 Abstract
  27. Andon MB, Howard MP, Moser PB, Reynolds RD. Nutritionally relevant supplementation of vitamin B6 in lactating women: effect on plasma prolactin. Pediatrics. 1985 Abstract
  28. Styslinger L, Kirksey A. Effects of different levels of vitamin B-6 supplementation on vitamin B-6 concentrations in human milk and vitamin B-6 intakes of breastfed infants. Am J Clin Nutr. 1985 Abstract
  29. Schaumburg H, Kaplan J, Windebank A, Vick N, Rasmus S, Pleasure D, Brown MJ. Sensory neuropathy from pyridoxine abuse. A new megavitamin syndrome. N Engl J Med. 1983 Abstract
  30. Scaglione D, Vecchione A. Pyridoxine for the suppression of lactation--a clinical trial on 1592 cases. Acta Vitaminol Enzymol. 1982 Abstract
  31. Vecchione A, Baccolo M. [Our experience in the inhibition of lactation (Controlled clinical study with bromocriptine, methergoline and pyridoxine)]. Riv Ital Ginecol. 1980 Abstract
  32. Thomas MR, Sneed SM, Wei C, Nail PA, Wilson M, Sprinkle EE 3rd. The effects of vitamin C, vitamin B6, vitamin B12, folic acid, riboflavin, and thiamin on the breast milk and maternal status of well-nourished women at 6 months postpartum. Am J Clin Nutr. 1980 Abstract
  33. Thomas MR, Kawamoto J, Sneed SM, Eakin R. The effects of vitamin C, vitamin B6, and vitamin B12 supplementation on the breast milk and maternal status of well-nourished women. Am J Clin Nutr. 1979 Abstract Full text (in our servers)
  34. Roepke JL, Kirksey A. Vitamin B6 nutriture during pregnancy and lactation. I. Vitamin B6 intake, levels of the vitamin in biological fluids, and condition of the infant at birth. Am J Clin Nutr. 1979 Abstract
  35. Greentree LB. Dangers of vitamin B6 in nursing mothers. N Engl J Med. 1979 Abstract
  36. Greentree LB. Inhibition of prolactin by pyridoxine. Am J Obstet Gynecol. 1979 Abstract
  37. Lehtovirta P, Ranta T, Seppälä M. Pyridoxine treatment of galactorrhoea-amenorrhoea syndromes. Acta Endocrinol (Copenh). 1978 Abstract
  38. de Waal JM, Steyn AF, Harms JH, Slabber CF, Pannall PR. Failure of pyridoxine to suppress raised serum prolactin levels. S Afr Med J. 1978 Abstract
  39. West KD, Kirksey A. Influence of vitamin B6 intake on the content of the vitamin in human milk. Am J Clin Nutr. 1976 Abstract
  40. Macdonald HN, Collins YD, Tobin MJ, Wijayarathne DN. The failure of pyridoxine in suppression of puerperal lactation. Br J Obstet Gynaecol. 1976 Abstract
  41. Canales ES, Soria J, Zárate A, Mason M, Molina M. The influence of pyridoxine on prolactin secretion and milk production in women. Br J Obstet Gynaecol. 1976 Abstract
  42. McIntosh EN. Treatment of women with the galactorrhea-amenorrhea syndrome with pyridoxine (vitamin B6). J Clin Endocrinol Metab. 1976 Abstract
  43. Marcus RG. Suppression of lactation with high doses of pyridoxine. S Afr Med J. 1975 Abstract
  44. Foukas MD. An antilactogenic effect of pyridoxine. J Obstet Gynaecol Br Commonw. 1973 Abstract

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