Synopsis

Source of validity: Scientific
Rating (out of 5): 2

Pyridoxal-5-phosphate (P-5-P), the active form of vitamin B6, has some scientific support for use in reducing certain chemotherapy side effects, although the evidence is limited and condition-specific. The most studied indication is chemotherapy-induced peripheral neuropathy (CIPN), particularly with agents like vincristine, isoniazid, and cisplatin. P-5-P is vital for normal nerve function and neurotransmitter synthesis, and deficiency can exacerbate neurotoxicity. Several small clinical trials and case reports suggest that vitamin B6 supplementation may decrease the severity of neuropathy in patients receiving neurotoxic chemotherapy. For example, a few studies in pediatric patients receiving vincristine reported reduced incidence and severity of neuropathy with pyridoxine or P-5-P supplementation. However, larger randomized controlled trials are lacking, and results are not universally consistent.

For other chemotherapy side effects (such as nausea, mucositis, or cytopenias), there is little direct evidence supporting a role for P-5-P. Most official guidelines do not routinely recommend P-5-P or vitamin B6 for chemotherapy side effect management, except in cases where deficiency is identified or when drugs with known B6 antagonism are used. Overall, the use of P-5-P for chemotherapy side effect reduction is based on biochemical rationale and small studies, but high-quality evidence is limited, resulting in a modest evidence rating.

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