Vitamin B6 and neuropathy: when a supplement can become a risk

Yes, too much vitamin B6 can damage nerves. Vitamin B6 toxicity neuropathy is a mainly sensory nerve problem that usually shows up as tingling, burning, numbness or pain in the feet and hands, sometimes with poorer balance. It is almost always linked to supplements taken over months or years, not to food, and the total can come from several products at once. It often improves after the extra B6 is stopped, but not always completely.^{2, 4, 11}

I have neuropathy myself, and I read supplement labels more carefully than I used to. B6 is one of the vitamins where “a little extra can’t hurt” turns out not to be true. At the same time, B6 is an essential vitamin, and a few people need it as treatment. I want to explain the risk clearly without making anyone afraid of a normal multivitamin.

When not to wait

• If you notice new tingling, burning or numbness in your hands or feet while taking a product that contains vitamin B6, contact your doctor or pharmacist promptly and bring the product with you. The warning that Australia’e
• s medicines regulator (TGA) requires on these labels tells people in that situation to stop taking the product and see a health practitioner as soon as possible.⁴
• If B6 was prescribed for a specific reason, for example alongside a tuberculosis medicine, talk to the prescriber before changing anything. B6 deficiency can also harm nerves.¹²
• If weakness spreads over hours or days, or you have trouble breathing or swallowing, call your local emergency number. That pattern can point to conditions such as Guillain-Barré syndrome, which a Canadian medical review says needs emergency assessment.¹⁸

Why isn’t vitamin B6 automatically harmless?

Many people assume the body simply gets rid of any extra B6 because it is water-soluble. That is too simple. The European Food Safety Authority (EFSA) says in its 2023 scientific opinion that the link between excess vitamin B6 intake and peripheral neuropathy is well established.¹

The US National Institutes of Health (NIH) fact sheet on B6 says that high intakes from food have not been reported to cause harm. The problems come from supplements. In the classic reports, people took 1 to 6 grams a day for 12 to 40 months and developed a severe, progressive sensory neuropathy with loss of coordination (ataxia).²

One of the first descriptions came in 1983, when doctors in the New England Journal of Medicine described seven adults with severe loss of sensation and unsteady walking after taking high-dose B6 every day. Weakness was not a feature, and they improved after stopping.¹³

Researchers still don’t fully understand why this happens. Laboratory studies suggest that pyridoxine, the form of B6 most often used in supplements, can block the active form of the vitamin, so large amounts may actually reduce B6 function inside nerve cells. Australia’s TGA calls it a paradox: the symptoms of too much B6 can look like the symptoms of too little.^{4, 21}

What does vitamin B6 toxicity neuropathy feel like?

The New Zealand medicines agency, Medsafe, lists burning, tingling or pricking sensations, increased sensitivity to touch, weakness, reduced reflexes and pain. The Dutch pharmacovigilance centre Lareb describes tingling, numbness or pain in the hands and/or feet.^{8, 9}

A review in Advances in Nutrition explains that excess pyridoxine mainly injures the sensory nerve cells, and StatPearls, a medical reference on the US National Library of Medicine’s bookshelf, describes numbness in a “stocking-glove” pattern and problems with balance. So it can feel much like other common kinds of polyneuropathy, which is why the supplement history matters.^{11, 14}

How much B6 is too much?

Official limits differ a lot, which makes the numbers confusing. All of them are in milligrams (mg) per day, not micrograms. For comparison, the NHS says adults need about 1.2 to 1.4 mg a day, which most people get from food.³

Who	Limit for adults	What it means
EFSA (European Union), 2023	12 mg a day from all sources	Tolerable upper intake level, also for pregnancy and breastfeeding; lower for children
US Food and Nutrition Board	100 mg a day	Tolerable upper intake level, set on older data
NHS (UK)	10 mg a day from supplements	“Unless advised to by a doctor”
Health Canada, 2026	Label warnings from 10 mg a day	Found a possible link with neuropathy at 10 mg a day or more in natural health products
TGA (Australia)	Label warning above 10 mg a day; stricter sale rules above 50 mg from June 2027	Products over 50 mg a day become pharmacist-only, over 200 mg prescription-only

Examples of official limits and warnings for vitamin B6.^{1, 2, 3, 4, 5, 7} They are safety limits for populations, not a personal dose or a diagnostic threshold.

EFSA based its limit on a reference point of 50 mg a day from a case-control study, divided by four to allow for the fact that symptoms appear sooner at higher doses and that the data are limited. EFSA also noted that people in the EU are unlikely to go over the limit unless they regularly take supplements with high doses of B6.¹

The US limit of 100 mg comes from older studies. NIH notes that the US Food and Nutrition Board was aware of case reports below 500 mg a day, but that studies of people taking an average of 200 mg a day for up to five years found no nerve damage.²

Newer reports have pushed attention to lower doses. Lareb in the Netherlands has received 238 reports of nerve pain in people using products with B6, and in 79 of them the product gave 12 mg a day or less. Australia’s TGA had 250 reports of neuropathy linked to B6 products by the end of October 2025 and says the risk is greatest at higher intakes but cannot be excluded below 50 mg a day. These are spontaneous reports, so they can’t prove that B6 caused every case, but a Drug Safety analysis of 90 Lareb reports judged the link plausible.^{4, 9, 10}

A population limit is not a personal line

An upper limit is set so that almost everyone in a population can take in that amount every day without harm. It is not a dose anyone should aim for, and it does not mean that going above it will cause neuropathy, or that staying below it rules B6 out. Whether B6 is part of your own symptoms is a question for a proper assessment, not for a label calculation.^{1, 2}

How can several supplements add up?

This is the part I think most people miss. Many products that are not sold as “vitamin B6” still contain it. The TGA advises health professionals to look closely at B vitamins, multivitamins and magnesium and zinc products, particularly when they are taken together, and to count foods and drinks with added B6 as well. Medsafe notes that B6 is common in multivitamin and mineral products such as zinc and magnesium supplements, and that people may not know they are taking it.^{4, 8}

In 2025 the TGA noted more than 1,500 products on its register with B6 as an active ingredient, including some magnesium products that provide close to 100 mg of B6 a day. In a case described in the Medical Journal of Australia, a person was taking a B-complex, a migraine product and a zinc product, which together gave 95 mg of B6 a day. Their blood B6 was very high, and their symptoms improved markedly after they stopped the products.^{6, 16}

The word “B6” isn’t always on the front. The TGA lists pyridoxine hydrochloride, pyridoxal 5-phosphate and pyridoxal 5-phosphate monohydrate as names that appear on Australian labels.⁴

A label checklist for your next appointment

This is a conversation aid I would use to prepare, not a way to diagnose yourself or set a dose:

• Every supplement, vitamin, mineral and “wellness” product you take, including ones you only use some days.
• For each one: the name of the B6 ingredient and the amount in mg per daily dose, as written on the label.
• How many tablets or capsules you actually take, which can differ from the label.
• How long you have taken each product.
• Energy drinks, protein shakes or fortified foods you have most days.
• Prescribed medicines, especially any that came with B6 as a partner medicine.
• When your nerve symptoms started, and whether that was before or after a new product.

StatPearls recommends a detailed review of every medicine and supplement, and suggests people bring their bottles to the appointment.¹¹

How is suspected B6-related neuropathy assessed?

There is no single test that proves B6 caused a neuropathy. The assessment usually brings together three things:

• A careful history of all supplements and medicines, and how long they have been used.¹¹
• A blood test for vitamin B6, usually measured as pyridoxal 5-phosphate (PLP). Mayo Clinic Laboratories, for example, asks for a 12-hour fast and no vitamin supplements for 24 hours beforehand, because its reference values come from fasting people who had not taken supplements.²⁰
• Nerve conduction studies and electromyography (EMG), which can show which nerves are affected and how. NINDS names excess vitamin B6 as one of the best-known vitamin-related causes of neuropathy and describes these tests as part of the work-up.¹⁹

Doctors will also look for other common causes. A review in the Canadian Medical Association Journal (CMAJ) lists the basic blood tests used for polyneuropathy, such as blood sugar, kidney and liver function and vitamin B12, so B6 is one piece of a wider picture.¹⁸

Timing matters as well. In the Australian case, the blood level fell steeply after the products were stopped. To me that suggests a normal result some time later doesn’t necessarily rule B6 out, which is one more reason to tell your doctor what you took and when.¹⁶

Can low vitamin B6 also cause neuropathy?

Yes, and that is why the answer is never simply “avoid B6”. StatPearls explains that the tuberculosis medicine isoniazid interferes with B6, so B6 is routinely given alongside it, and that people with kidney failure on dialysis often have low B6 levels. Some epilepsy and Parkinson’s medicines are also mentioned. A systematic review in Nutrients describes both deficiency and high intake as possible risk factors for neuropathy, while the evidence for deficiency as a cause is weaker.^{12, 15}

The same review found that B6 at permitted daily doses, for example in a normal multivitamin, has not been shown to be harmful for people who already have neuropathy. That is worth keeping in mind before throwing out every supplement in the cupboard.¹⁵

Does B6 neuropathy go away after stopping?

Often it improves, but it can take a long time and may not be complete. NIH says symptoms usually stop if the supplements are stopped as soon as nerve symptoms appear. StatPearls says nerve function improves after stopping and usually settles within six months, but some people do not recover.^{2, 11}

The review in Advances in Nutrition describes a pattern where symptoms can get worse for a while after stopping, a phenomenon called “coasting”, before slowly improving. Large improvements were usually seen within about six months, but reduced sensation in the feet or hands often remained.¹⁴

The newer reports are less reassuring. Only a third of the 238 people who reported to Lareb said they had recovered after stopping, and in a small Korean series of eight mostly older patients who had taken 50 or 100 mg a day, there was no clear improvement after one year. The NHS notes that in a few cases, large doses taken for many months can cause permanent damage. For those of us already living with nerve damage, that is a good reason to catch it early rather than later.^{3, 9, 17}

Avoiding both false reassurance and alarm

Two things are true at once. B6 is an established cause of neuropathy, and many supplements contain far more than the body needs. But B6 is still essential, and sometimes medically needed as a treatment.

What I take from the research is this: know your total, know how long you have been taking it, and tell your doctor or pharmacist about everything, including products you think of as harmless. Questions I would bring:

• Do any of my products contain vitamin B6, and what is my total amount per day?
• Could B6 be part of my nerve symptoms, and is a B6 blood test useful in my case?
• Do I need any of these supplements for a specific reason?
• If B6 may be involved, what is the plan, and how will we follow up my symptoms?
• What else should we check if my symptoms don’t improve?

I’m not a doctor. I’ve written this from published research and guidance, and to help you prepare questions for your own care.

Sources

1. EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA), Turck D, Bohn T, Castenmiller J, et al. Scientific opinion on the tolerable upper intake level for vitamin B6. EFSA Journal 2023;21(5):8006. doi:10.2903/j.efsa.2023.8006. https://efsa.onlinelibrary.wiley.com/doi/10.2903/j.efsa.2023.8006
2. NIH Office of Dietary Supplements. Vitamin B6 – Fact Sheet for Health Professionals. Updated 16 June 2023. https://ods.od.nih.gov/factsheets/VitaminB6-HealthProfessional/
3. NHS. Vitamins and minerals – B vitamins and folic acid. Page last reviewed 3 August 2020. https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-b/
4. Therapeutic Goods Administration (TGA), Australian Government. Medicines containing vitamin B6 (pyridoxine, pyridoxal or pyridoxamine). Safety update, updated after the final decision of 25 November 2025. https://www.tga.gov.au/news/safety-updates/medicines-containing-vitamin-b6-pyridoxine-pyridoxal-or-pyridoxamine
5. Therapeutic Goods Administration (TGA). Notice of final decision to amend (or not amend) the current Poisons Standard – pyridoxine, pyridoxal, pyridoxamine (vitamin B6). 25 November 2025. https://www.tga.gov.au/sites/default/files/2025-11/notice-final-decision-to-amend-current-poisons-standard-pyridoxine-pyridoxa-pyridoxamine-vitamin-b6.pdf
6. Therapeutic Goods Administration (TGA). Notice of interim decision to amend (or not amend) the current Poisons Standard – pyridoxine, pyridoxal, pyridoxamine (vitamin B6). 26 June 2025. https://www.tga.gov.au/sites/default/files/2025-06/notice-interim-decision-amend-or-not-amend-current-poisons-standard-pyridoxine-pyridoxal-pyridoxamine-vitaminb6.pdf
7. Health Canada. Summary Safety Review – Vitamin B6 health products – Assessing the potential risk of peripheral neuropathy. Drug and Health Product Portal, published March 2026 (announced in Health Product InfoWatch, April 2026). https://dhpp.hpfb-dgpsa.ca/review-documents/resource/SSR1773147434487
8. Medsafe (New Zealand Medicines and Medical Devices Safety Authority). Vitamin B6 (pyridoxine) and peripheral neuropathy. Prescriber Update, 5 June 2025. https://www.medsafe.govt.nz/profs/PUArticles/June2025/Vitamin-B6-and-peripheral-neuropathy.html
9. Netherlands Pharmacovigilance Centre Lareb. Nerve damage due to the use of nutritional supplements with vitamin B6. 13 November 2024. https://www.lareb.nl/en/news/nerve-damage-due-to-the-use-of-nutritional-supplements-with-vitamin-b6/
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17. Ko J, Kang S-Y. Case series of pyridoxine-induced neuropathy. Journal of Medicine and Life Science 2024;21(1):11–14. doi:10.22730/jmls.2024.21.1.11. https://www.e-jmls.org/journal/view.php?doi=10.22730%2Fjmls.2024.21.1.11
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Sources checked on 25 September 2026.