What are the recommendations for thiamine (Vitamin B1) supplementation and treatment of deficiency?

From the Guidelines

Thiamine supplementation is crucial in preventing and treating deficiency, with recommendations varying based on the severity of deficiency and clinical presentation, and the most recent guideline suggests administering thiamine 100-300 mg/day IV in patients admitted to emergency or intensive care for 3-4 days 1.

Key Recommendations

• For mild deficiency or prevention in at-risk individuals, oral thiamine at 10 mg/day for a week, followed by 3-5 mg/day for at least 6 weeks is recommended 1.
• For moderate to severe deficiency, particularly in conditions like Wernicke encephalopathy or alcoholic patients, initial treatment should be intravenous thiamine at 500 mg three times daily for 2-3 days, followed by 250 mg daily for 3-5 days, then transitioning to oral maintenance therapy of 50-100 mg daily 1.
• For patients at risk of deficiency, such as those with chronic diuretic therapy, a dose of 50 mg a day, by mouth is suggested 1.
• In cases of high suspicion or proven deficiency, 200 mg, 3 times a day, IV is recommended 1.

Clinical Considerations

• Thiamine deficiency can have severe consequences, including Wernicke encephalopathy, and prompt treatment is essential to prevent long-term neurological damage 1.
• Patients with malnutrition, chronic alcoholism, bariatric surgery, or prolonged vomiting are at highest risk and may require ongoing supplementation 1.
• Thiamine is water-soluble and generally safe even at high doses, with minimal side effects, making it a crucial component of treatment and prevention strategies 1.

Administration Routes

• In cases of suspicion of chronic deficiency without any acute disease, the oral route is adequate, while in cases of acute disease, the suspicion of inadequate intake, even short term, should prompt the use of the IV route 1.
• For patients admitted to emergency or intensive care, the administration of thiamine (100-300 mg/day IV) should be prescribed without hesitation from admission for 3-4 days 1.

From the FDA Drug Label

Indications and Usage 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. Dosage and Administration “Wet” beriberi with myocardial failure must be treated as an emergency cardiac condition, and thiamine must be administered slowly by the IV route in this situation In the treatment of beriberi, 10 to 20 mg of thiamine hydrochloride are given IM three times daily for as long as two weeks. An oral therapeutic multivitamin preparation containing 5 to 10 mg thiamine, administered daily for one month, is recommended to achieve body tissue saturation.

The recommendations for thiamine supplementation and treatment of deficiency are:

• IV administration of thiamine hydrochloride is indicated for rapid restoration of thiamine in cases such as Wernicke’s encephalopathy, infantile beriberi with acute collapse, cardiovascular disease due to thiamine deficiency, or neuritis of pregnancy with severe vomiting.
• IM administration of 10 to 20 mg of thiamine hydrochloride three times daily for up to two weeks is recommended for the treatment of beriberi.
• Oral administration of a multivitamin preparation containing 5 to 10 mg of thiamine daily for one month is recommended to achieve body tissue saturation.
• Correction of poor dietary habits and prescription of an abundant and well-balanced dietary intake are also recommended 2, 2, 3.

From the Research

Thiamine Supplementation and Treatment of Deficiency

• Thiamine deficiency is a common issue in patients with alcohol dependence, and it can lead to cognitive impairments, Wernicke's encephalopathy, and other serious health problems 4, 5.
• The optimal thiamine dose for treating or preventing Wernicke's encephalopathy is not well established, and studies have shown no significant differences between different dosage regimens 6.
• Recommendations for thiamine supplementation vary, but general guidelines include:
  • Parenteral thiamine 200-500mg three times a day for 3-5 days, followed by oral thiamine 250-1000mg/day, for patients with established Wernicke's encephalopathy 4.
  • Parenteral thiamine 250-300mg two times a day for 3-5 days, followed by oral thiamine 250-300mg/day, for patients with suspected Wernicke's encephalopathy 4.
  • Parenteral thiamine 250-500mg/day for 3-5 days, followed by oral thiamine 250-300mg/day, for patients at high risk of thiamine deficiency 4.
  • Oral thiamine 250-500mg/day for 3-5 days, followed by oral thiamine 100-250mg/day, for patients at low risk of thiamine deficiency 4.
• Thiamine deficiency can also occur in critically ill patients, and intravenous thiamine can help correct lactic acidosis, improve cardiac function, and treat delirium 7.
• Dry beriberi, a condition caused by thiamine deficiency, can manifest as acute inflammatory demyelinating polyneuropathy, and thiamine replacement therapy can lead to slow improvement 8.