Document Reference
MM 092
Guidelines for prescribing Thiamine in Alcohol-use Disorders
Approved by the Drugs and Therapeutics Committee
16 May 2014
Review date: 16 May 2017
G/TGH/Chief Pharmacist/ Policies/ Guidelines/Guidelines for prescribing thiamine in alcohol-use disorders.
Version 1. May 2014
1.
INTRODUCTION
This guidance is intended for Pennine Care NHS Foundation Trust’s mental health staff
and aims to encourage consistent working practices. It is based on current good practice
as described in National Institute for Health and Care Excellence Clinical Guideline 100
Alcohol-use disorders: physical complications (2010). It aims to clarify the role of thiamine
and Vitamin B Compound Strong tablets in alcohol-use disorders and identify at-risk
groups who should be prescribed them.
Thiamine is used to treat and prevent Wernicke-Korsakoff syndrome (WKS) which may
develop in problem drinkers. WKS comprises Wernicke’s encephalopathy (mental
confusion, ataxia and ophthalmoplegia) followed, if inadequately treated, by Korsakoff’s
syndrome.
People who are dependent on alcohol are often malnourished and deficient in vitamins. In
particular thiamine deficiency is common, due to poor diet, poor absorption (caused by
gastritis), and a high demand for the vitamin (it is a co-enzyme in alcohol metabolism).
This document should be read in conjunction with Trust Guidelines for the management of
alcohol withdrawal and prevention of Wernicke-Korsakoff Syndrome (MM018)
2.
ASSESSMENT
The patient is usually mentally alert, with vocabulary and comprehension maintained.
Symptoms may include:
 Vision changes, abnormal eye movement
 Loss of muscle co-ordination, abnormal gait
 Loss of memory
 Hallucinations
Assessment should involve a clinical history and examination including liver function tests.
The strength, amount, frequency and time period of alcohol use should be established,
along with usual dietary intake. Dietary advice needs to be provided to reduce or prevent
malnourishment.
3.
PATIENTS WHO SHOULD BE OFFERED THIAMINE SUPPLEMENTATION
Patients who are at high risk of developing or suspected of having WKS.
Oral thiamine should be offered to harmful or dependent drinkers if any of the following
apply:
 They have decompensated liver disease
 They are in acute alcohol withdrawal
 Medically-assisted alcohol withdrawal is planned
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They are malnourished or have
Poor diet
Weight loss in past year
Reduced BMI
Loss of appetite
Nausea and vomiting
DOSE OF THIAMINE TO BE PRESCRIBED
If the person is in reasonable health with an adequate diet:
 Prescribe oral thiamine 200 – 300mg per day (in divided doses) whilst they are
undergoing assisted withdrawal, or are drinking excessively

Prescribe oral thiamine 50mg per day (as a single dose) during the maintenance
stage following withdrawal, and for as long as malnutrition may be present.
If the person is in poor health with signs of severe malnutrition, consider admitting for
intramuscular administration of thiamine for 5 days. This can then be followed by oral
supplementation as above.
If the person has chronic alcohol dependence, oral thiamine may need to be continued
indefinitely.
5.
VITAMIN B COMPOUND STRONG TABLETS
Vitamin B Compound Strong tablets do not contain enough thiamine for
treatment/prophylaxis of WKS. They are licensed for the treatment of clinical and
subclinical vitamin B deficiency states.
They have been used historically in patients with alcohol-use disorder, however NICE
guidance CG 100 makes no reference to the use of Vitamin B Compound Strong tablets
due to insufficient evidence to support this.
The use of Vitamin B Compound Strong tablets for the treatment or prophylaxis of WKS is
therefore not recommended.
6.
REFERENCES
National Institute for Health and Care Excellence. Clinical Guideline 100: Alcohol-use
disorders
physical
complications.
June
2010.
Available
from
http://guidance.nice.org.uk/CG100/Guidance/pdf/English [Accessed 22nd April 2014].
G/TGH/Chief Pharmacist/ Policies/ Guidelines/Guidelines for prescribing thiamine in alcohol-use disorders.
Version 1. May 2014
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National Institute for Health and Care Excellence. Public Health guidance 24. Alcohol-use
disorders: preventing the development of hazardous and harmful drinking. Available from
http://www.nice.org.uk/guidance/PH24 [Accessed 22nd April 2014]
Prodigy. Alcohol-problem drinking. Available from http://cks.nice.org.uk/alcohol-problemdrinking#azTab [Accessed 22nd April 2014]
Ang CD, Alviar MJM, Dans AL, Bautista-Velez GGP, Villaruz-Sulit MVC, Tan JJ, Co HU,
Bautista MRM, Roxas AA. Vitamin B for treating peripheral neuropathy. Cochrane
Database of Systematic Reviews 2008, Issue 3.
Art. No.: CD004573.
DOI:
10.1002/14651858. CD004573.pub3.
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