From the Guidelines
For alcohol use disorder, the recommended dosage is typically 100-300 mg of thiamine daily, as indicated by the most recent guideline from 2022 1. The administration of thiamine should be prescribed without hesitation from admission for 3-4 days, especially in patients admitted to emergency or intensive care.
- The dosage of thiamine can be administered by either oral or IV route, depending on the patient's condition.
- For folic acid, the recommended dosage is not explicitly stated in the most recent guideline for alcohol use disorder, but a general recommendation for multivitamin and mineral supplement providing 400- to 800-μg folic acid per day can be considered 1.
- However, it is crucial to prioritize the most recent and highest quality study, which in this case is the espen micronutrient guideline from 2022 1, and consider the specific context of alcohol use disorder.
- The supplements are crucial because chronic alcohol use impairs thiamine absorption and utilization, potentially leading to Wernicke-Korsakoff syndrome, while folate deficiency is common in alcohol users and can contribute to anemia and neurological problems.
- These supplements should be administered alongside comprehensive treatment for alcohol use disorder, including counseling and possibly medications like naltrexone or acamprosate.
- For severely malnourished patients or those with symptoms of Wernicke's encephalopathy, thiamine should be given intravenously before administering any glucose to prevent precipitating or worsening encephalopathy.
From the FDA Drug Label
Although most patients with malabsorption cannot absorb food folates, they are able to absorb folic acid given orally... In the presence of alcoholism, hemolytic anemia, anticonvulsant therapy, or chronic infection, the maintenance level may need to be increased. 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 folic acid for alcohol use disorder is up to 1 mg daily and the recommended dose of thiamine is up to 30 mg three times a day (or 90 mg daily) 2 3.
From the Research
Thiamine and Folic Acid for Alcohol Use Disorder
- The daily dosage of thiamine for patients with alcohol use disorder can vary, but according to 4, patients with established Wernicke's encephalopathy should receive parenteral thiamine 200-500mg three times a day for 3-5 days, followed by oral thiamine 250-1000mg/day.
- For patients with suspected Wernicke's encephalopathy, parenteral thiamine 250-300mg should be given two times a day for 3-5 days, followed by oral thiamine 250-300mg/day 4.
- Patients at high risk of thiamine deficiency should receive parenteral thiamine 250-500mg/day for 3-5 days, followed by oral thiamine 250-300mg/day 4.
- However, there is no specific information available on the recommended dosage of folic acid for patients with alcohol use disorder in the provided studies.
- It is essential to note that while thiamine is often prescribed to patients with alcohol use disorder, the provided studies do not mention the use of folic acid in this context 5, 6, 4, 7, 8.