Vitamin B group (Formulary)

Important: Formulation and dosage details

Formulation:

Tablets 50mg, 100mg

Dosage:

• Mild deficiency: 25mg daily
• Severe deficiency: 200mg to 300mg daily in divided doses.
• Patients with alcohol dependence: should be prescribed oral thiamine 200mg to 300mg daily in divided doses:
  • before planned withdrawal of alcohol
  • during acute withdrawal of alcohol
  • for up to 12 months after acute withdrawal of alcohol, indefinitely in some cases
  • for patients not undergoing alcohol withdrawal but at high risk of developing Wernicke's encephalopathy.

Important: Formulation and dosage details

Formulation:

Solution for injection 50mg/mL

Dosage:

Indication: Thiamine deficiency: Particularly for the treatment of alcohol dependence and the management of refeeding syndrome (where oral/enteral route is not available or suitable).

Dosage: As per BNF and local guidance.

Guidelines:

NHS Highland:

• Unplanned alcohol withdrawal (Guidelines) | Right Decisions
• Refeeding syndrome in adults (Guidelines) | Right Decisions
• Patient Group Direction For The Administration / Supply of Thiamine 250mg5ml Intramuscular Injection To Patients Undergoing Alcohol Detoxification By Approved Registered Nurses In NHS Highland – under review with NHSH PPG
• Community alcohol detoxification and planned alcohol detoxification at New Craigs Hospital (add link once published)

National:

• SPS: Using and prescribing thiamine in alcohol dependence – SPS - Specialist Pharmacy Service – The first stop for professional medicines advice
• SPS: Prescribing and using thiamine to prevent refeeding syndrome – SPS - Specialist Pharmacy Service – The first stop for professional medicines advice

Important: Formulation and dosage details

Formulation:

Tablets 10mg, 50mg

Dosage:

• Deficiency: 20 to 50mg up to 3 times daily.
• Isoniazid induced neuropathy:
  • Prophylaxis: 10mg daily
  • Treatment 50mg 3 times daily. 
• Idiopathic sideroblastic anaemia: 100 to 400mg daily in divided doses.

Notes:

• The use of pyridoxine in premenstrual syndrome off-label is of doubtful value.
• Overdosage induces toxic effects.

Important: Formulation and dosage details

Formulation:

High potency injection intravenous, intramuscular

Dosage:

• Guidance:
  • Pabrinex shortage: Specialist Pharmacy Service: Prescribing and using thiamine in patients at risk of refeeding syndrome
  • Unplanned alcohol withdrawal guideline.
  • For the administration in primary care settings refer to the PGD.

Important: Formulation and dosage details

Formulation:

Vitamin B compound strong tablets nicotinamide 20mg, pyridoxine hydrochloride 2mg, riboflavin 2mg, thiamine hydrochloride 5mg (Restricted: Hospital use only)

Dosage:

• For refeeding syndrome as per guideline: Refeeding policy
• Specialist Pharmacy Service: Prescribing and using thiamine in patients at risk of refeeding syndrome

Prescriptions are for a maximum of one month.