*For medical professionals only
Do you know this common compatibility taboo?
Do you also encounter some compatibility problems: the instructions are not clear, and the "Table of Contraindications to the Compatibility of Commonly Used Drugs" does not show the compatibility contraindications between them, but there are occasional changes or adverse reactions in the application.
As a pharmacist, I don't know how to judge the prescription, as a doctor, I don't know whether to use it together, as a nurse, I don't know whether to space...
Today's small medicine to reveal the long-standing problem that has puzzled readers, is there a compatibility contraindication between vitamin C and vitamin B6?
First, let's understand the protagonist vitamin C and vitamin B6
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 disorders and energy supplementation for acute and chronic infectious diseases, while vitamin B6 is used to treat nausea caused by radiation therapy, pregnancy vomiting, diarrhea and so on. In the clinic, many prescriptions combine vitamin C, vitamin B6 and potassium chloride to treat patients with chronic diarrhea, and say that the combination of drugs can effectively promote the recovery of diarrhea.
Is there a contraindication to the compatibility of vitamin B6 with vitamin C?
Vitamin C and vitamin B6 are also commonly used drugs in clinical practice, is there a compatibility contraindication between them?
Jie XiaoYao consulted a lot of information, and there was no evidence of "real hammer" (such as instructions or guidelines) to show that there were indeed compatibility taboos between the two. But "often walk by the river where there are not wet shoes", vitamin C + vitamin B6 compatibility taboo is still found by us, I hope to give you a little hint or warning.
■From a redox point of view
Vitamin B is an amphoteric compound whose oxidation is greater than reductivity.
Vitamin C has strong reducivity, when vitamin C is combined with vitamin B, a redox reaction may occur, and vitamin C will promote the destruction of vitamin B into reductive vitamin B and lose its efficacy.
Based on this, vitamin B drugs should not be used in combination with vitamin C.
■From the perspective of adverse reactions
In a 410-patient report of adverse reactions to vitamin B6 injection, 282 cases were adverse reactions in combination with vitamin B6 injection and vitamin C injection [1]. Clinical manifestations are mostly chills, high fever, rash and so on.
There have also been reports [2] of adverse reactions/events (ADR/ADE) of the combination of two drugs, including pallor, purple lips, general convulsions, and pruritus [2].
Table 1 Clinical manifestations of ADR combined with vitamin C and vitamin B6 injection[1]
■From a case point of view
In 2018, three cases of adverse reactions in children caused by intravenous infusion of vitamin C and vitamin B6 injections were reported[2], and the key information is summarized as follows:
Case 1
The child was male, 1 year and 4 months old, with a body mass of 11 kg. Diagnosis: vomiting, diarrhea.
outburst
After 0.9% sodium chloride injection 100mL + vitamin C injection 1.0g + vitamin B6 injection 0.1g, intravenous infusion, inlet speed 30 drops / min, when the infusion is about 20ml, the child appears pale, purple lips, and convulsions all over the body.
dispose
Immediately stop the infusion, give oxygen 2 liters / min, phenobarbital sodium injection 0.05 g intramuscular injection, observe for about 15 minutes the child's face gradually reddened, lips purple lightened, after 1 hour the vital signs were stable.
Case 2
Children, 3 years and 2 months, body mass 15 kg. Diagnosis: hyperthermic convulsions.
First intramuscular injection of phenobarbital sodium injection, hydrocortisone sodium succinate pushed quietly; then 5% GS100ml + vitamin C injection 1.0g + vitamin B6 injection 0.1g, intravenous infusion, instillation rate of 40 drops / min, indoctrination for about 15 minutes, the child felt facial and neck itching, found that the skin was red, now more rashes, eyelid swelling.
Immediately stop the infusion and give Karritan syrup oral administration for mental comfort. After about 10 minutes, the color of the child's skin returned to normal, and the symptoms gradually eased.
Case 3
The child was male, 2 years and 2 months old, with a body mass of 13 kg. Diagnosis: fever.
After 5% GS100ml + vitamin C injection 1.0g + vitamin B6 injection 0.1g, intravenous infusion, 40 drops / min, instillation for about 20 minutes, the child has chills, limb twitches, binocular gaze, and ungodly, accompanied by symptoms of cyanosis of the lips.
After 0.9% sodium chloride injection 100mL intravenous drip, after giving hydrocortisone sodium succinate 5mg static push, the convulsions lasted for about 3 minutes after relief, about 20 minutes after the above symptoms gradually disappeared and improved, and continued treatment in hospitalization.
Judging from the recommended dosage of vitamin C injection (0.05-0.3 g in children) in the literature [4], the dose of these three children was obviously too large, the concentration of the drug solution was high, and the amount of vitamin B6 injection had reached the upper limit of a single day. At the same time, the report mentioned that the 3 children had no history of drug allergies and should not be sensitive physiques.
However, from the perspective of drip rate, Example 1 used 30 drops / min, the other 2 cases used 40 drops / min, the occurrence of adverse reactions at a fast rate of drip is also faster, although it is temporarily impossible to directly determine whether the two are directly linked, but it is significantly higher than the infant 15-20 drops / min, preschool children 20-30 drops / minute requirements [5], increasing the risk of adverse reactions.
The above suggests that vitamin C and vitamin B6 have adverse reactions after compatibility. The risk of adverse effects may be related to the population taking the drug, the dose of the drug, and the rate of instillation.
Vitamin B6 compatibility contraindicated large inventory
It is worth noting that there is no description of the contraindications to compatibility in the instructions for vitamin B6. We also hope that the drug instructions can be improved. The table of contraindications to vitamin B compatibility is summarized for everyone's reference in clinical medication.
Table Table Of contraindications to vitamin B compatibility
For drug compatibility contraindications, we often pay attention to the compatibility of drugs in the same infusion bag, and ignore the "encounter" of drugs in the infusion tube when changing drugs.
The drug changes in compatibility in the infusion tube, and if the precipitation crystal is generated, it is not only easy to block the infusion tube, but also may cause some chemical reaction to produce toxic substances, or cause the body to microcirculation to produce some adverse reactions.
Therefore, in the clinical infusion process, the tube should be punched when the tube should be punched, and the interval should be spaced, and must not be careless.
Once the compatible drug appears discoloration, turbidity, flocculent, precipitation, crystallization should be stopped immediately, to avoid adverse reactions, so that the efficacy can be played stably.
bibliography:
Yin Yuanyuan, Huo Hongyan, Yu Ping, Adverse reactions of vitamin B6 injection in 410 cases[J]. Journal of Kunming University, 2021, 03: 119-124
ZHANG Lei. Intravenous infusion of vitamin C and vitamin B6 injections caused adverse reactions in children in 3 cases[J]. Chinese Journal of Drug Abuse Prevention, 2018, 24 ( 4): 234 - 235.
Wang Xuqin, Pan Jingjing, Zhang Qiaoping. Compatibility of 15 Drugs with Vitamin B6 Injection Is Contraindicated[J]. China Rural Medicine, 2015(17):83-84.
[4] Chen Xinqian, Jin Youyu, Tang Guang . New Edition pharmacology[M].17th edition . Beijing:People's Medical Publishing House,2011:781-782.]
LI Xiaolan. Influencing Factors of Intravenous Infusion Rate in Children and Mastering of Drip Rate[J]. Modern Distance Education in Traditional Chinese Medicine,2009,7(7):79-80.]
Wei X, Ouyang X L, Xu Ying, et al. Compatibility of omeprazole sodium for injection with ornidazole, vitamin B6 and levofloxacin[J]. Pharmacy Service and Research, 2013, 13(001):12-15.
Ding Chunhua. There are contraindications to the compatibility of Qingkailing injection with vitamin B6[J]. Nursing Research, 2004.
ZHAO Na. There are contraindications to the compatibility of acyclovir with vitamin B6 injection[J]. PLA Nursing Journal, 2007(2):57-57.
Li Wei. There are contraindications to the compatibility of infancy between insurgenics for injection and vitamin B6 injection[J]. Chinese Journal of Tissue Engineering, 2012, 11(B05):71-71.
Zhao Ya, Tang Jinfa, Zhang Hui, et al. Compatibility stability between Danhong injection and vitamin B6 injection[J]. China Journal of New Drugs, 2016(14):1647-1651.
CHEN Xiaoqiang. Contraindications to Hydyampine Compatible Vitamin B6[J]. Journal of Rational Clinical Use of Drugs, 2012(30):31-32.
Cui Lihua. There are contraindications to the compatibility of a variety of trace element injections (II.) with vitamin B6[J]. Shanxi Medical Journal, 2010, 39(9):895-895.
AI Dongfang. Stability of Compatibility of Traditional Chinese Medicine Injection with Vitamin B6 Injection[J]. Chinese Pharmacist, 2007, 10(8):820-820.
Note: The remaining * standard sources of published medical literature are pubmed and will not be listed one by one.
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