Thiamine (Vitamin B1)

Indications

  • Thiamine Deficiency (see Thiamine Deficiency)
    • Infantile Beriberi
    • Dry Beriberi
    • Wet Beriberi
    • Wernicke-Korsakoff Syndrome

Pharmacology

Normal Thiamine Physiology

  • Thiamine is a Water-Soluble Vitamin: therefore, thiamine is not stored
    • Thiamine Toxicity is Not Observed, Since Kidneys are Capable of Clearance of Almost All Excess Thiamine
    • Biologic Half-Life: 10-20 days

Administration

Recommended Daily Thiamine Intake

  • PO
    • Female ≥19 y/o: 1.1 mg
    • Pregnancy/Lactation: 1.4 mg
    • Male ≥19 y/o: 1.2 mg

Ethanol Withdrawal (see Ethanol, Ethanol)

  • Standard Prophylaxis Regimen
    • Administer 100 mg/day IV (Usually in a “Banana Bag” Which Includes Folate and Multivitamin) x Several Days, Followed by 50-100 mg PO day
  • Royal College of Physicians High-Dose Thiamine Prophylaxis Regimen for Wernicke’s Encephalopathy (Administered in Addition to Other B Vitamins, Ascorbic Acid, Potassium, Magnesium, and Phosphate) (Alcohol Alcohol, 2002) [MEDLINE]
    • Administer 250 mg IV qday x 3-5 Days

Thiamine Deficiency (Beriberi and/or Wernicke’s Encephalopathy) (see Thiamine Deficiency, Thiamine Deficiency)

  • Standard Regimen
    • Administer 100 mg IV qday (Usually in a “Banana Bag” Which Includes Folate and Multivitamin) Until Patient is Tolerating a Balanced Oral Diet
    • However, Higher Thiamine Doses May Be Required in Patients Who Do Not Clinically Improve on the Standard Regimen
  • Royal College of Physicians High-Dose Thiamine Regimen for the Treatment of Wernicke’s Encephalopathy (Administered in Addition to Other B Vitamins, Ascorbic Acid, Potassium, Magnesium, and Phosphate) (Alcohol Alcohol, 2002) [MEDLINE]
    • Administer 500 mg IV TID x 3 Days, Followed by 250 mg IV qday x 5 Days (or Until Clinical Improvement is Observed)

References

  • The Royal College of Physicians report on alcohol: guidelines for managing Wernicke’s encephalopathy in the accident and Emergency Department. Alcohol Alcohol. 2002 Nov-Dec;37(6):513-21 [MEDLINE]