From the Guidelines
For patients with alcohol use disorder, the recommended dose of thiamine is 100-300 mg/day IV for 3-4 days, as stated in the most recent guideline 1. This dose is recommended for patients admitted to emergency or intensive care, and should be prescribed without hesitation from admission.
- The administration of thiamine is crucial in patients with alcohol use disorder, as chronic alcohol use impairs thiamine absorption and utilization, while increasing its requirements.
- Thiamine supplementation is essential to prevent neurological complications like Wernicke's encephalopathy and Korsakoff syndrome.
- The IV route is the most efficient way to administer thiamine, providing 3 x 100-300 mg per day, as recommended in the guideline 1.
- It is also important to note that thiamine should be administered before glucose in malnourished alcoholic patients to prevent precipitating or worsening Wernicke's encephalopathy.
- The recommended dose and administration route may vary depending on the clinical situation, but the guideline provides a clear recommendation for the initial treatment of patients with alcohol use disorder 1.
From the FDA Drug Label
OVERDOSAGE: Parenteral doses of 100 to 500 mg singly have been administered without toxic effects. However, dosages exceeding 30 mg three times a day are not utilized effectively. The recommended dose of thiamine for alcohol use (etoh) is not explicitly stated, but the label mentions that dosages exceeding 30 mg three times a day are not utilized effectively.
- The effective dose is 30 mg three times a day or less, as higher doses are not utilized effectively 2.
From the Research
Thiamine Dosing for Alcohol Use
- The appropriate dose of thiamine for patients with alcohol use disorder and Wernicke's encephalopathy is not well established, with various studies suggesting different dosing regimens 3, 4, 5, 6, 7.
- A review of the literature found that doses of thiamine ranging from 100 to 1500 mg intravenous and up to 300 mg intramuscular, with no apparent difference in patient outcomes 3.
- A randomized controlled trial found no significant differences between thiamine doses of 100 mg daily, 100 mg thrice daily, or 300 mg thrice daily for the prevention of Wernicke's encephalopathy in asymptomatic at-risk patients, and no significant differences between doses of 100 mg thrice daily, 300 mg thrice daily, or 500 mg thrice daily for the treatment of symptomatic patients 4.
- Other studies suggest the following dosing regimens:
- 25 mg four times a day for patients with alcohol use disorder 5.
- 200-500 mg three times a day for 3-5 days, followed by oral thiamine 250-1000 mg/day for patients with established Wernicke's encephalopathy 6.
- 250-300 mg two times a day for 3-5 days, followed by oral thiamine 250-300 mg/day for patients with suspected Wernicke's encephalopathy 6.
- High-dose intravenous thiamine for patients with suspected Wernicke's encephalopathy, with simultaneous treatment of magnesium deficiency 7.
Administration Route
- Parenteral or intramuscular thiamine administration is recommended for patients with confirmed alcohol-induced Wernicke's encephalopathy 3.
- Intravenous thiamine administration is preferred for patients with suspected Wernicke's encephalopathy 5, 7.
- Oral thiamine administration may be suitable for patients at low risk of thiamine deficiency, such as those with uncomplicated alcohol dependence 6.