Bedside Clinical Question
· What is the dosing regimen for Thiamine in patients with Alcohol Use Disorder?
Background
· Alcohol Use Disorder is a chronic disease characterized by uncontrolled dependence on alcohol. Chronic alcohol use can lead to malnutrition and vitamin deficiencies by reducing your appetite and making it difficult for the body to process and absorb important nutrients.
· Vitamin B1, also known as Thiamine, is a water-soluble vitamin that is essential for glucose metabolism, especially within the brain. In the absence of Thiamine, this metabolic pathway is impaired leading to a decreased energy production and increased oxidative stress in brain cells.
· Wernicke encephalopathy (WE) is a serious condition that affects the brain and is caused by a lack of Thiamine. This condition is most commonly seen in people who are malnourished and dependent on alcohol, but it can also occur due to malnutrition from other causes.
Answer
· Thiamine prevents Wernicke's encephalopathy by supporting brain glucose metabolism, acting as a cofactor for enzymes and mitigating neurological damage.
· Thiamine repletion helps restore depleted Thiamine levels, reducing the risk of severe brain damage and associated cognitive impairments. Dosing regimens are as follows:
Prevention for patients with alcohol withdrawal syndrome: 100 mg IV or PO once daily for 3 to 5 days. The route depends on patient tolerance and risk of aspiration.
Treatment for patients showing sign of WE: IV (preferred route initially) 500 mg every 8 hours for 2 days, followed by 250 mg once daily for an additional 3 to 5 days, followed by maintenance therapy of 100 mg daily until no longer at risk for deficiency. An alternative regimen is for some providers to omit the 250 mg daily dosing and after the 500 mg every 8 hours for 2 days go straight to 100 mg daily.
Conclusion
· In summary, Thiamine supplementation is crucial for individuals with Alcohol Use Disorder to prevent conditions like Wernicke's encephalopathy. This intervention is vital in restoring Thiamine levels, reducing severe brain damage, and improving overall patient outcomes.
Written by: Aonyea Spinks-Boykins, P4 Pharmacy Student, MWU Doctor Pharmacy Candidate
Reviewed by: Joanne C Routsolias, PharmD, RN, BCPS
References
Latt N, Dore G. Thiamine in the treatment of Wernicke encephalopathy in patients with alcohol use disorders. Internal Medicine Journal. 2014;44(9):911-915. doi:https://doi.org/10.1111/imj.12522.
Dervaux A, Laqueille X. Thiamine (vitamin B1) treatment in patients with alcohol dependence. Presse medicale (Paris, France : 1983). 2017;46(2 Pt 1):165-171. doi:https://doi.org/10.1016/j.lpm.2016.07.025.
Thomson AD, Marshall EJ. The treeatment of patients at risk for developing Wernicke's encephalopathy in the community. Alcohol and Alcoholism. 2005;41(2):159-167. doi:https://doi.org/10.1093/alcalc/agh250