Vitamin Supplementation

Warning

Prevention of Thiamine Deficiency in Alcohol Dependent Patients

Preferred list (P)

THIAMINE tablets

  • Recommended dose: 50mg four times a day.

Prescribing Notes:

  • There is no evidence to support the use of vitamin B compound or vitamin B compound strong.

Treatment of Wernicke’s Encephalopathy

Specialist use only (S2)

PABRINEX® intramuscular or intravenous solution for injection

  • Pabrinex® should be given to patients at risk of Wernicke’s encephalopathy i.e. those who are confused, ataxic, vomiting or generally debilitated.
  • By intravenous infusion: 2–3 pairs 3 times a day for 3–5 days, followed by 1 pair once daily for a further 3–5 days or for as long as improvement continues.
  • Oral thiamine is indicated for less severe cases while receiving detoxification treatment for 5 to 7 days.
  • Patients who resume drinking or continue to drink and are at risk of malnourishment should be given oral supplements (200mg thiamine daily) on a long-term basis.

There are ongoing supply issues with Pabrinex® (Vitamins B and C) Intravenous and Intramuscular High Potency solution for injection ampoules. 

  • See Medicine Supply Notification MSN/2024/038 for more information.
  • Pabrinex® Intravenous (IV) injection will be out of stock from August 2024 until at least September 2025.
  • Pabrinex® Intramuscular (IM) injection is being discontinued, with stock exhaustion expected from December 2024.
  • There are no other licensed parenteral alternatives to Pabrinex® IV and IM injections.
  • Thiamine 50mg and 100mg tablets remain available and should be used where clinically appropriate.

NHSL Joint Adult Formulary Key

To indicate the category of a formulary medicine, updated sections adopt the following key:

Preferred list (P): First-line formulary choices.

 

Total list (T): Alternative choices when preferred list options not effective/not tolerated, or not indicated.

 

Specialist initiation (S1): Specialist initiation, or on the advice of a Consultant or Specialist Practitioner in this therapeutic area. Continuation in primary care is acceptable.

 

Specialist use only (S2): Supply via hospital, Homecare Service or a hospital based prescription (HBP) for dispensing by community pharmacy. Not prescribed in primary care setting.

Editorial Information

Last reviewed: 31/01/2022

Next review date: 31/01/2025

Author(s): NHSL.

Version: Please refer to the introduction section for an explanation of the review dates above.

Approved By: ADTC

Reviewer name(s): ADTC.