Vitamin Supplementation

NHSL Medicines Guidance
NHS Lanarkshire

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

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

  • See Medicine Supply Notification MSN/2024/038 for more information.

  • Branded Pabrinex® Intravenous (IV) injection will be out of stock from August 2024 with no firm resupply date currently available. 

  • Pabrinex® Intramuscular (IM) injection has been discontinued, with stock exhaustion expected from December 2024.

  • Thiamine 50mg and 100mg tablets remain available and should be used where clinically appropriate.

Specialist use only (S2)

VITAMINS B+C HIGH POTENCY INTRAVENOUS INFUSION

  • Vitamins B+C Intravenous High Potency concentrate for solution for infusion 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 of ampoules 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.

THIAMINE HYDROCHLORIDE 50mg/ml SOLUTION FOR INJECTION

  • Licensed for the treatment of Wernicke's encephalopathy associated with alcohol addiction and/or alcohol withdrawal syndrome and prevention of Wernicke-Korsakoff syndrome.
  • To be used in the outpatient detoxification setting for acute alcohol withdrawal syndrome. 
  • Preferred preparation for use within mental health inpatient settings. 
  • Licensed for intra-muscular administration. See Summary of Product Characteristics for more information.

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: 21/05/2025

Next review date: 30/06/2026

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.