• All patients undergoing alcohol detoxification should be given parenteral vitamins B and C (Pabrinex®) as prophylaxis for Wernicke’s encephalopathy in addition to oral thiamine. 
  • Due to the concern of long-term brain injury, and the low risk and cost of treatment, the index of suspicion for considering Wernicke’s in these patients should be high and the threshold for considering the treatment recommendations low.
  • Refer to Drugs used in substance dependence and Unplanned alcohol withdrawal guideline.

THIAMINE (VITAMIN B1)

Important: Therapy notes

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.

PYRIDOXINE (VITAMIN B6)

Important: Therapy notes

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.

PARENTERAL VITAMINS B AND C

Important: Therapy notes

Important: Formulation and dosage details

Formulation:

High potency injection (Pabrinex®) intravenous, intramuscular

Dosage:

Editorial Information

Document Id: F317