*For medical professionals only
Do you know this common incompatibility?
Whether you will also encounter some doubts about compatibility issues: the instructions are not clear, and the Common Drug Compatibility Table does not show the compatibility between them. Contraindicated, but occasional changes or adverse reactions occur in application.
Today, Xiaoyao will reveal the question that has puzzled readers for a long time. Is there any incompatibility between vitamin C and vitamin B6?
Let’s learn about vitamin C and vitamin B first6
Vitamin C (L-ascorbic acid) and vitamin B6 (pyridoxine hydrochloride) are both water-soluble vitamins.
Vitamin C is widely used in the treatment of scurvy, as well as energy supplement for acute and chronic infectious diseases; while vitamin B6 is used in the treatment of nausea, vomiting, diarrhea, etc. caused by radiation therapy. In clinical practice, many prescriptions use vitamin C, vitamin B6 and potassium chloride together to treat patients with chronic diarrhea, and it is indicated that the drug combination can effectively promote the recovery of diarrhea.
Vitamin B6Is there a contraindication to Vitamin C?
Vitamin C and vitamin B6 are also commonly used drugs in clinical practice. Is there any incompatibility between them?
Jie Xiaoyao has consulted a lot of information, and there is no “real hammer” evidence (such as instructions or guidelines) to show that the two are indeed incompatible. But “how can you walk by the river without wet shoes”, we have discovered the incompatibility of vitamin C + vitamin B6, and hope to give you some hints or warnings.
■From a redox perspective
Vitamin B is an amphoteric compound that is more oxidative than reductive.
Vitamin C has strong reducing properties. When vitamin C and vitamin B are combined, redox reactions may occur. Vitamin C will promote the destruction of vitamin B into reducing vitamin B and lose its efficacy. .
Based on this, B vitamins should not be used in combination with vitamin C.
■From the perspective of adverse reactions
In a report of 410 adverse reactions of vitamin B6 injection, there were 282 cases of adverse reactions in the combination of vitamin B6 injection and vitamin C injection [1]. The clinical manifestations are mostly chills, high fever, rash and so on.
It has also been reported [2] that the clinical manifestations of adverse reactions/events (ADR/ADE) with the combination of the two drugs include pale complexion, purplish lips, generalized convulsions, itching, etc. [2].
Table 1 Clinical manifestations of ADR combined with vitamin C and vitamin B6 injection[1]
■From a case perspective
In 2018, 3 cases of adverse reactions in children caused by intravenous infusion of vitamin C and vitamin B6 injections were reported [2]. The key information is summarized as follows:
Case 1
The child is a male child, 1 year and 4 months old, weighing 11kg. Diagnosis: vomiting, diarrhea.
Burst
To 0.9% Sodium Chloride Injection 100mL+Vitamin C Injection 1.0g+Vitamin B6 Injection 0.1g, intravenous drip, drip rate 30 drops/min, when there is about 20ml left , The child appeared pale, his lips were purple, and his body twitched.
Processing
Stop the infusion immediately, give oxygen inhalation 2 liters/min, intramuscular injection of phenobarbital sodium injection 0.05g, and observe for about 15 minutes that the child’s complexion becomes reddish, the lips become less purple, 1 Vital signs were stable after hours.
Case 2
Child girl, 3 years and 2 months, weight 15kg. Diagnosis: Febrile seizures.
Burst
First intramuscular injection of phenobarbital sodium injection, hydrocortisone sodium succinate intravenous injection; followed by 5% GS100ml+vitamin C injection 1.0g+vitamin B6 injection 0.1g, Intravenous infusion at a rate of 40 drops/min. About 15 minutes after infusion, the child felt itching on the face and neck, and found that the skin was red, there were many rashes, and the eyelids were swollen.
Processing
Stop the infusion immediately and take Claretan syrup orally for mental comfort. After about 10 minutes, the skin color of the child returned to normal, and the symptoms gradually eased.
Case 3
The child is a male child, 2 years and 2 months old, weighing 13kg. Diagnosis: Fever.
Burst
To 5% GS100ml+Vitamin C Injection 1.0g+Vitamin B6 Injection 0.1g, intravenous drip, drip rate 40 drops/min, about 20 minutes after instillation, the child developed chills, Limb twitching, eyes staring, reluctance, accompanied by symptoms of cyanosis of the lips.
Processing
Intravenous infusion of 0.9% sodium chloride injection 100mL, followed by intravenous injection of hydrocortisone sodium succinate 5mg, the convulsion lasted for about 3 minutes and then relieved, and the above symptoms gradually gradually occurred after about 20 minutes Disappeared and improved, and went to hospital to continue treatment.
Judging from the recommended dosage of vitamin C injection in the literature (0.05-0.3g for children)[4], the dosage of these 3 children was obviously too large, the concentration of the liquid was high, and the The dosage of vitamin B6 injection has also reached the daily upper limit. At the same time, the report mentioned that none of the 3 children had a history of drug allergy and should not be considered sensitive.
However, from the point of view of the dripping speed, the case 1 used 30 drops/min, the other 2 cases used 40 drops/min, and the adverse reactions occurred faster with the faster dripping rate, although it was temporarily impossible to directly To determine whether there is a direct connection between the two, it is significantly higher than the requirements of 15-20 drops/min for infants and 20-30 drops/min for preschool children [5], which increases the risk of adverse reactions.
The above all suggest that vitamin C and vitamin B6 have adverse reactions after the compatibility. The risk of adverse reactions may be related to the drug population, drug dose and drug infusion rate.
Vitamin B6Incompatibility Checklist
It is worth noting that there is no statement related to incompatibility in the instructions for vitamin B6. We also hope that drug inserts can improve the relevant content. The vitamin B incompatibility table is now summarized for your reference for clinical medication.
Table Vitamin B Incompatibility Table
For drug compatibility contraindications, we often pay attention to the compatibility of drugs in the same infusion bag, but ignore the “meeting” of drugs in the infusion tube during dressing change.
The compatibility of the drug in the infusion tube changes. If the precipitation and precipitation crystals are formed, it will not only easily block the infusion tube, but also may cause a certain chemical reaction to produce toxic substances, or cause the microcirculation of the human body to block and produce some Adverse reactions listed.
Therefore, in the process of clinical infusion, the tube should be flushed when the tube should be flushed, and the interval should be spaced, and it must not be careless.
In case of discoloration, turbidity, flocculent, precipitation, or crystallization of the compatible drug, it should be discontinued immediately to avoid adverse reactions and stabilize the efficacy of the drug.
References:
[1] Yin Yuanyuan, Huo Hongyan, Yu Ping, Analysis of 410 cases of adverse reactions of vitamin B6 injection [J]. Journal of Kunming University, 2021,03:119-124
[2] Zhang Lei. Three cases of adverse reactions in children caused by intravenous infusion of vitamin C and vitamin B6 injection［J］． Chinese Journal of Drug Abuse Prevention and Control, 2018, 24(4): 234-235.
[3] Wang Xuqin, Pan Jingjing, Zhang Qiaoping. Incompatibility of 15 drugs with vitamin B6 injection[J]. China Rural Medicine, 2015(17):83-84.< /p>
[4] Chen Xinqian, Jin Youyu, Tang Guang. New Pharmacology [M]. 17th Edition. Beijing: People’s Health Publishing House, 2011:781-782.
[5] Li Xiaolan. Influencing factors of intravenous infusion rate and control of drip rate in children［J］． Modern Distance Education of Chinese Medicine in China, 2009, 7(7): 79-80.
[6] Wei Xi, Ouyang Xiaolin, Xu Ying, et al. Incompatibility of omeprazole sodium for injection with ornidazole, vitamin B6 and levofloxacin[J]. Pharmaceutical service and Research, 2013, 13(001):12-15.
[7] Ding Chunhua. The incompatibility of Qingkailing injection and vitamin B6[J]. Nursing Research, 2004.
[8] Zhao Na. The incompatibility of acyclovir and vitamin B6 injection[J]. PLA Nursing Journal, 2007(2):57-57.
[9] Li Wei. Preservation of Yanhuning for injection and vitamin B6 injectionIncompatibility taboo[J]. Chinese Tissue Engineering Research, 2012, 11(B05):71-71.
[10] Zhao Ya, Tang Jinfa, Zhang Hui, et al. Study on the compatibility and stability of Danhong injection and vitamin B6 injection [J]. China Journal of New Drugs, 2016(14): 1647-1651.
[11] Chen Xiaoqiang. Contraindication analysis of Xiyanping combined with vitamin B6[J]. Journal of Clinical Rational Drug Use, 2012(30):31-32.
[12] Cui Lihua. Incompatibility of various trace element injections (Ⅱ) and vitamin B6[J]. Shanxi Medicine Journal, 2010, 39(9):895-895.
[13] Ai Dongfang. Stability of compatibility between Chinese medicine injection and vitamin B6 injection[J]. Chinese Pharmacist, 2007, 10(8):820-820.
Note: The medical literature pubmed published by the other sources marked with * will not be listed one by one.
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