Cyanocobalamin Dosing for Acute Alcohol Withdrawal
No Specific Cyanocobalamin Dosing Recommendation Exists for Acute Alcohol Withdrawal
Cyanocobalamin (Vitamin B12) is not routinely indicated or dosed specifically for acute alcohol withdrawal management. The available guidelines do not provide dosing recommendations for cyanocobalamin in this clinical context 1.
What You Should Actually Be Giving: Thiamine
The critical vitamin supplementation in acute alcohol withdrawal is thiamine (Vitamin B1), not cyanocobalamin (Vitamin B12). This distinction is essential to prevent life-threatening complications 2, 3.
Thiamine Dosing for Acute Alcohol Withdrawal
- Administer thiamine 100-300 mg IV daily for 3-5 days immediately upon presentation 3
- For suspected Wernicke's encephalopathy, escalate to 500 mg IV three times daily 3
- Always give thiamine BEFORE any glucose-containing IV fluids, as glucose can precipitate acute Wernicke's encephalopathy in thiamine-depleted patients 4, 3
Maintenance Therapy
- Continue oral thiamine 50-100 mg/day for 2-3 months after resolution of acute withdrawal symptoms 4, 3
- For prevention of Wernicke's encephalopathy: 100-300 mg/day for 4-12 weeks 4
When Cyanocobalamin Might Be Relevant
While not part of acute withdrawal management, cobalamin deficiency should be assessed in alcoholic patients who present with:
Standard Cyanocobalamin Dosing (If Deficiency Identified)
Critical Pitfall to Avoid
The most dangerous error is confusing B12 (cyanocobalamin) with B1 (thiamine). Thiamine deficiency affects 30-80% of alcohol-dependent patients and can cause fatal Wernicke's encephalopathy if not treated immediately 4. Cyanocobalamin does not prevent this complication and should not be substituted for thiamine 2, 3.
Complete Acute Alcohol Withdrawal Management
Beyond vitamin supplementation, acute alcohol withdrawal requires: