{"entity":{"id":"vitamin-b6-pyridoxine","kind":"technology","name":"Vitamin B6 (pyridoxine) for hand-foot syndrome and other uses","aka":["Pyridoxine","Vitamin B6 supplements"],"tldr":"Vitamin B6 is often suggested to prevent the sore, peeling hands and feet caused by capecitabine and similar drugs, but several randomised trials found it did not help. Long-term high doses can themselves damage nerves, sometimes permanently.","summary":"Hand-foot syndrome is a common side effect of capecitabine, fluorouracil infusions and pegylated liposomal doxorubicin, and pyridoxine has been used for it empirically. Memorial Sloan Kettering's About Herbs entry reports that several randomised trials did not find benefit, although higher doses may help and one study found fewer capecitabine dose modifications and less severe hand-foot syndrome without any effect on how well chemotherapy worked. Dietary B6 is associated with lower risk of colorectal and some other cancers, but MSK notes that supplements do not show the same association: in the Women's Health Study, B6 with B12 and folate did not reduce breast or invasive cancer risk, and long-term supplementation was associated with more lung cancer, especially in male smokers. High intakes cause sensory and motor neuropathy and ataxia; MSK describes three elderly patients taking 600 mg a day for years whose neuropathy had not improved two years after stopping. B6 also reduced the effect of the chemotherapy drug altretamine in one study and speeds the breakdown of levodopa. Urea-based creams, dose adjustment and, for capecitabine, the guidance of the treating team remain the main management.","status":"negative","asOf":"2026-11-04","links":[{"label":"MSK About Herbs: Vitamin B6 (page last updated 5 October 2023)","url":"https://www.mskcc.org/cancer-care/integrative-medicine/herbs/vitamin-b6"}],"tags":["complementary","supportive-care","evidence:no-benefit"],"related":["vitamin-b12-supplements","folic-acid-supplements"],"cancers":[],"sections":["supportive-care","chemotherapy","nutrition-lifestyle"],"technologies":["integrative-oncology","dietary-supplements-treatment-interactions"],"targets":[],"drugs":["capecitabine","fluorouracil","altretamine"],"companies":[],"institutions":[],"pathways":[],"terms":["hand-foot-syndrome","peripheral-neuropathy"],"trials":[],"people":[],"bottlenecks":["b-toxicity-qol"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"principle":"Pyridoxal phosphate is a cofactor for more than 100 enzymes in amino acid and one-carbon metabolism; at high circulating levels it is directly toxic to sensory ganglion neurons.","strengths":["Cheap and widely available","Deficiency, for instance with isoniazid, is correctly treated with it"],"limitations":["Several randomised trials for hand-foot syndrome were negative","High doses cause neuropathy that may not reverse","Reduced the effect of altretamine; supplements associated with lung cancer in male smokers"]},"route":"/technologies/vitamin-b6-pyridoxine/","neighbours":{"technology":[{"id":"dietary-supplements-treatment-interactions","kind":"technology","name":"Dietary supplements during cancer treatment: interactions and harms","route":"/technologies/dietary-supplements-treatment-interactions/"},{"id":"integrative-oncology","kind":"technology","name":"Evidence-based integrative oncology","route":"/technologies/integrative-oncology/"},{"id":"folic-acid-supplements","kind":"technology","name":"Folate and folic acid supplements","route":"/technologies/folic-acid-supplements/"},{"id":"vitamin-b12-supplements","kind":"technology","name":"Vitamin B12 supplements","route":"/technologies/vitamin-b12-supplements/"}],"section":[{"id":"chemotherapy","kind":"section","name":"Chemotherapy","route":"/fronts/chemotherapy/"},{"id":"nutrition-lifestyle","kind":"section","name":"Diet, Exercise & Lifestyle","route":"/fronts/nutrition-lifestyle/"},{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"drug":[{"id":"altretamine","kind":"drug","name":"Altretamine","route":"/drugs/altretamine/"},{"id":"capecitabine","kind":"drug","name":"Capecitabine","route":"/drugs/capecitabine/"},{"id":"fluorouracil","kind":"drug","name":"Fluorouracil (5-FU)","route":"/drugs/fluorouracil/"}],"term":[{"id":"hand-foot-syndrome","kind":"term","name":"Hand-foot syndrome and hand-foot skin reaction","route":"/terms/hand-foot-syndrome/"},{"id":"peripheral-neuropathy","kind":"term","name":"Peripheral neuropathy (chemotherapy-induced)","route":"/terms/peripheral-neuropathy/"}],"bottleneck":[{"id":"b-toxicity-qol","kind":"bottleneck","name":"Toxicity and quality of life are undervalued","route":"/bottlenecks/b-toxicity-qol/"}]}}