Trip Answers

Question answered:04/09/06 Warning! this question is over two years old.

There would appear to be a lack of evidence to fully answer your question.

PRODIGY has a guideline on problem drinking [1] which includes a section on B vitamins, which reports:

“People with chronic alcohol dependence are frequently malnourished and deficient in vitamins, especially thiamine, largely because of reduced absorption

The SIGN guideline recommends that people who have a chronic alcohol problem and whose diet may be deficient should be given oral thiamine indefinitely

There is limited evidence for recommending a dosage of thiamine in the treatment of alcohol dependence. 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.

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.

Anyone undergoing alcohol detoxification at home should be given oral thiamine (200 mg daily) for 5-7 days

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).”

Much of the PRODIGY guideline is based on an earlier SIGN guideline [2] which may be of interest.

Neither guideline suggests a multivitamin or gives a timescale for continuing thiamine supplements once the person has stopped drinking alcohol. 

References

1) PRODIGY. Alcohol - problem drinking. 2004 (http://www.prodigy.nhs.uk/alcohol_problem_drinking/view_whole_guidance)
2) SIGN. The management of harmful drinking and alcohol dependence in primary care. 2003 (http://www.sign.ac.uk/pdf/sign74.pdf)

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