4.10.4.4 Vitamin supplementation

Oral Prophylaxis

Low risk of Wernicke’s Encephaopathy (WE)

ChoiceDrugDosage
1st choiceThiamine (vitamin B1) tablets 100mgDose:
Oral: 100mg three times daily. Single doses above 100mg do not enhance oral absorption and should be avoided

Prescribing Notes

  • Refer to NI Alcohol Use Disorders Care Pathway – management in the acute hospital setting
  • Oral thiamine can be considered for those at low risk (mild alcohol dependence with an adequate diet)
  • 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 thiamine 50mg or 300mg daily, according to local protocol, on a long-term basis
  • Clients undergoing community detoxification should also be considered for parenteral prophylaxis with Pabrinex® because oral thiamine is not adequately absorbed and there is considerable doubt about the usefulness of oral replacement. However, parenteral administration of thiamine is not always possible in the community setting. In this case, low-risk drinkers without neuropsychiatric complications and with an adequate diet should be offered oral thiamine: a minimum of 300mg daily during assisted alcohol withdrawal and periods of high alcohol intake
  • Due to lack of evidence, vitamin B complex preparations (Vitamin B compound and Vitamin B compound strong) should not be prescribed for prevention of Wernicke’s Encephalopathy (WE) in alcoholism. In rare cases where there might be a justifiable reason for prescribing e.g. medically diagnosed deficiency or chronic malabsorption, Vitamin B compound strong and not vitamin B compound should be prescribed as it represents better value for money. For further details see SPS website

Parenteral Prophylaxis

Prescribing notes

  • Parenteral thiamine (Pabrinex®) is indicated for prophylaxis of WE in those at moderate-high risk and for treatment of suspected or confirmed WE.
  • Treatment is given under the care of a specialist and Pabrinex® should usually be administered in hospitals or health centres where facilities for treating anaphylaxis are available
  • The following patients should be considered to be at moderate-high risk of Wernicke’s Encephaopathy (WE):
    • Patients who are alcohol dependent where there is evidence of malnutrition, physical illness or complicated withdrawal
    • Patients who show evidence of malnourishment or are at risk of malnourishment
    • Decompensated liver disease
    • Attending the Emergency Department or are admitted to hospital with acute illness or injury
    • Homelessness
    • Hospitalised for co-morbidity of another alcohol issue
  • Refer to NI Alcohol Use Disorders Care Pathway – management in the acute hospital setting