Trip Answers

Question answered:14/12/06 Warning! this question is over two years old.

In March 2005 the NLH Primary Care Q & A Service answered a question on the use of thiamine/vitamin B supplementation in chronic alcoholic use and during alcohol withdrawal. We have updated the literature search using the NLH Library, TRIP and Medline databases but have found no new guidance or studies on this topic, thus we consider our answer posted in March 2005 to be current and will therefore reproduce this answer below [1].

 

PRODIGY have published a guideline “Alcohol – problem drinking” [2].  In the section “When should I recommend vitamin B supplements?” they have two subsections:

 

Vitamin B supplements in chronic deficiency

 

- People with chronic alcohol dependence are frequently malnourished and deficient in vitamins, especially thiamine, largely because of reduced absorption [Cook and Thomson, 1997].
- The SIGN guideline recommends that people who have a chronic alcohol problem and whose diet may be deficient should be given oral thiamine indefinitely (GPP) [DH et al, 1999; SIGN, 2003].
- There is limited evidence for recommending a dosage of thiamine in the treatment of alcohol dependence [Berglund et al, 2003]. The BNF recommended dose is:
Severe deficiency: 200-300 mg per day. This should be given in divided doses to maximize absorption.
Mild chronic deficiency: 10-25 mg per day.

 

Vitamin B supplements during detoxification

 

- Detoxification may precipitate Wernicke's encephalopathy, which must be treated urgently with parenteral thiamine. Signs of possible Wernicke-Korsakoff syndrome (which may progress to encephalopathy) in someone undergoing detoxification include:
Confusion
Ataxia
Ophthalmoplegia
Nystagmus
Memory disturbance
Hypothermia and hypotension
Coma

 

- Anyone who presents with unexplained neurological signs or symptoms should be referred for specialist assessment. [SIGN, 2003]
- Anyone undergoing alcohol detoxification at home should be given oral thiamine (200 mg daily) for 5-7 days [DTB, 2000].
- People who are severely malnourished or have long-standing dependence are at highest risk of developing clinical manifestations of thiamine deficiency during alcohol withdrawal. There is a strong argument for admitting such at-risk people to hospital during detoxification for parenteral administration of vitamin supplements (Pabrinex®). [DTB, 2000; SIGN, 2003]

 

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References
1. NLH Q & A Service. For how long should thiamine and vitamin B compound be continued in alcohol withdrawal? Posted March 2005. (http://www.clinicalanswers.nhs.uk/index.cfm?question=288).
2.PRODIGY. Alcohol – problem drinking. 2004 (http://www.prodigy.nhs.uk/guidance.asp?gt=Alcohol%20-%20problem%20drinking

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