From the FDA Drug Label
Thiamine hydrochloride injection is effective for the treatment of thiamine deficiency or beriberi whether of the dry (major symptoms related to the nervous system) or wet (major symptoms related to the cardiovascular system) variety Thiamine hydrochloride injection should be used where rapid restoration of thiamine is necessary, as in Wernicke’s encephalopathy, infantile beriberi with acute collapse, cardiovascular disease due to thiamine deficiency, or neuritis of pregnancy if vomiting is severe.
The treatment of Wernicke’s encephalopathy with thiamine (IV) may help alleviate symptoms related to the nervous system, but the label does not directly mention nerve palsy as a specific condition that can be treated with thiamine (IV) 1.
- Nerve palsy is not explicitly mentioned in the provided drug labels.
- The labels discuss the treatment of conditions such as Wernicke’s encephalopathy and beriberi, but do not provide information on nerve palsy specifically. The FDA drug label does not answer the question.
From the Research
Wernicke's encephalopathy with associated nerve palsy requires immediate treatment with high-dose thiamine (vitamin B1) supplementation, as recommended by the most recent study 2. The recommended regimen is 500 mg of thiamine administered intravenously three times daily for 2-3 days, followed by 250 mg intravenously or intramuscularly once daily for 3-5 days, and then oral thiamine 100 mg daily for maintenance. This treatment should be initiated before administering any glucose-containing fluids, as glucose can precipitate or worsen the condition in thiamine-deficient patients, as noted in the study 3. Wernicke's encephalopathy is caused by thiamine deficiency, commonly seen in alcoholics, malnourished patients, or those with prolonged vomiting, and presents with the classic triad of confusion, ataxia, and ocular abnormalities including nerve palsies (particularly affecting cranial nerves III, IV, and VI), as described in the study 4. The nerve palsies manifest as nystagmus, lateral rectus palsy, conjugate gaze palsies, and ptosis. Some key points to consider in the treatment of Wernicke's encephalopathy include:
- Prompt treatment is essential as untreated Wernicke's encephalopathy can progress to Korsakoff syndrome (characterized by severe memory impairment) or even death, as highlighted in the study 5.
- Patients should receive comprehensive nutritional support, alcohol cessation counseling if applicable, and close monitoring for improvement of neurological symptoms, as recommended in the study 6.
- The use of high-dose thiamine has been shown to be effective in treating Wernicke's encephalopathy, even in patients without traditional risk factors, such as those with COVID-19, as noted in the study 2.