Hello - I am a new member here. My local neurologist has prescribed me Metanx (and Ive viewed the sticky on supplements). However, I saw a neurologist that specialized in pain who wants no b6 supplementation at all saying it can cause pain. My b6 level was at the low end of the range at 40. What I have been able to research is that very high levels of b6 can cause neuropathy but these were considered toxic doses. My doctor prescribing Metanx has given me a script to have b6 and b12 levels draw n a month after taking it. I'd appreciate any thoughts that might help me make a decision in light of these divergent opinions. BTW I have SFPN from autoimmune disease and am being treated with Trileptal, but it wears off by 3-4 pm. I am also having IvIg done monthly staggered with bolus steroids. Thanks!

You can buy the ingredients of Metanx over the counter and leave the B6 out.

Methylcobalamin and methylfolate (Solgar) you can get yourself.

There is quite a bit of folate in Metanx, and you may not need the really high dose. Start at 800mcg/day.

http://www.iherb.com/Solgar-Folate-A...0-Tablets/1396

Methylcobalamin
http://www.iherb.com/Natural-Factors...-Tablets/27648
2 of these a day ON AN EMPTY STOMACH....

I would ask that doctor for specific proof that B6 causes "pain".
B6 is a cofactor in serotonin manufacture, and that is often a treatment for chronic pain patients...to increase serotonin actions in the brain.

Doctors only know there were in the past a few reports on really high intake of B6...500mg a day for a long time to affect nerves negatively. Low B6 also causes neuropathies, probably far more often than any high reading.

What is the risk of the high folate content? I also take Deplin 15mg.Thanks Mrs. D.

So then, all you need is the methylcobalamin.

There has been some concern about excess folate being involved
with triggering or feeding cancers..esp of the colon. But this is still being bantered around in the studies.

http://www.ncbi.nlm.nih.gov/pubmed/21915934

I visited a new neurologist for a second opinion on Monday. He did inquire as to if I were taking "megadoses" of B6 or any supplements that contain B6 as part of the formula. This was a fairly young guy, so the issue with B6 seems to be one that they are teaching the new guys about. I was visiting for SFNP issues by the way.

On an unrelated topic, I visited my pain management Doc on Tuesday and he enrolled me into a study looking at any potential benefits of gabapentin in a topical creme delivery system. This reminded me, Mrs. D, of your discussion of magnessium as a topical cream (Morton's). If effective, such an application of gabapentin could potentially cut down on some of the side-effects associated with the oral dose.

Well, the topical creams with drugs in them do help some people, and sometimes quite a bit.

Gabapentin however is thought to work in the spinal cord, so putting it on feet seems futile, to me. But even that is only a theory.

Many of the formulas are "shotgun mixtures" with several things in them, so separating out what is working and what is not, is difficult.

There are few if any studies on these compounded items, so data on effectiveness of separate items is lacking. The FDA does not investigate compounded items so, we really don't know what is beneficial and what not.

The value of the transdermal products is that dosage is lower, since the drugs don't have to go thru the first past liver circulation from the GI tract.

They are worth a try. I do find the magnesium lotion is very effective for me, personally. So I would try that first.... at $5.98 it is not much of a burden or harmful.