Does it currently make sense to restrict vitamin B6 so severely since taking Sinemet, Madopar, etc.?

VITAMIN B6 AND LEVODOPA-CARBIDOPA (SINEMET), benserazide (Madopar), etc.

Does it currently make sense to restrict vitamin B6 so severely since taking Sinemet (Levodopa with Carbidopa), Madopar (Levodopa with Benserazide), etc?

INFORMATION: between 10 and 25 mg of vitamin B6 would be the limit for prudence. Always consult a neurologist.

Merck, the manufacturer, tells us in the information pamphlet insert of Sinemet:

"Pyridoxine hydrochloride (vitamin B6), in oral doses of 10 mg to 25 mg, may reverse the effects of levodopa by increasing the rate of aromatic amino acid decarboxylation.

Carbidopa inhibits this action of pyridoxine; therefore, SINEMET can be given to patients receiving supplemental pyridoxine (vitamin B 6)."

Link:

https://www.merck.com/product/usa/pi_circulars/s/sinemet/sinemet_pi.pdf

CONCLUSION:

The manufacturer of Sinemet itself states that doses below 10 mg were not a problem when levodopa was taken alone. And that now, with Carbidopa, it can be taken with a pyridoxine or vitamin B6 supplement (at least up to 25 mg). Why Merck's concern? Because without enough vitamin B6 levodopa cannot be converted to dopamine in the brain.

This is the amount that the prestigious neurologist J Eric Ahlskog prescribes for his Parkinson's patients: 25 mg of B6, 2.5 of B9 and 1-2 mg of B12 (or 1000-2000 micrograms), to reduce the level of the dangerous homocysteine (which levodopa raises). Captured from page 426 in the image.

CAUTION: Always consult your neurologist anyway. And if you feel bad, trying lower doses and supplementing with food may be an option to consult with the specialist.

As a reference, about 50 pistachios contain 0.5 mg of pyridoxine or vitamin B6 (if storage conditions have been good).