Thiamine (Vitamin B1) - Uses, Dose, MOA, Brands, Side effects

Thiamine (Vitamin B1) is a co-enzyme in carbohydrates metabolism. It is mainly used to treat the following conditions:

  • Thiamine deficiency (including thiamine deficiency in pregnancy associated with neuropathy)
  • Beriberi (dry or wet variety)
  • Wernicke encephalopathy
  • Infantile beriberi with acute collapse
  • Cardiovascular disease due to thiamine deficiency
  • Before giving Intravenous dextrose to individuals with marginal thiamine status to prevent precipitation of heart failure
  • Dietary supplement.

Off Label Use of Thiamine (Vitamin B1) in Adults include:

  • Alcohol withdrawal syndrome
  • Ethylene glycol poisoning
  • Severe sepsis or septic shock

Thiamine (Vitamin B1) Dose in Adults

Thiamine (Vitamin B1) Dose in the treatment of Marginal thiamine status (to avoid precipitating heart failure):

  • 100 mg Intravenous thiamine is added in each of the first few liters of Intravenous fluid in patients with borderline thiamine status to whom dextrose is being administered.

Parenteral nutrition supplementation :

  1. 6 mg/day Intravenous.

Thiamine Dose in the treatment of Thiamine deficiency (beriberi):

  • It is given via Intramuscular or Intravenous route 3 times a day @ 5 to 30 mg/dose (if severe illness).
  • Then 5 - 30 mg orally daily in single or divided doses 3 times daily for 30 days.
  • Manufacturer's labeling:

    • 10 to 20 mg via Intramuscular route three times a day for 14 days followed by an oral multivitamin tablet which contains 5 to 10 mg thiamine given daily for 1 month.

Thiamine Dose in the treatment of Alcohol withdrawal syndrome (off-label):

  • 100 - 250 mg intramuscular or intravenous once a day for 3 - 5 days followed by 100 mg orally 3 times a day for 7 - 14 days then 100 mg orally daily afterward.

Thiamine Dose in the treatment of Ethylene glycol poisoning (off-label):

  • 100 mg Intravenous once a day until the intoxication has settled.

Thiamine Dose in the treatment of severe sepsis or septic shock (off-label): ​​​​​​​

  • 200 mg given Intravenously twice a day over 30 minutes for 4 days or until the patient is discharged from ICU.
  • Deliver in combination with Intravenous ascorbic acid (vitamin C) and Intravenous hydrocortisone.

Thiamine Dose in the treatment of Wernicke encephalopathy:

  • Prophylaxis (off-label):
    • 100 - 250 mg given via Intravenous or Intramuscular route once daily for 3 to 5 days,
    • then 100 mg orally three times a day for 7 to 14 days
    • followed by 100 mg orally daily.
  • Treatment:
    • Initial: It is given Intravenous 200 - 500 mg three times daily for 2 - 7 days.
    • If a response to thiamine is detected, then progress with 250 mg Intravenous or Intramuscular once daily for further 3 to 5 days (or until clinical improvement ends) followed by 30 mg orally twice daily thereafter or 100 mg orally three times a day for 1 to 2 weeks followed by 100 mg orally once a day thereafter.
  • Manufacturer's labeling:
    • Initially: 100 mg Intravenous, then 50 - 100 mg Intramuscular daily.

Thiamine (Vitamin B1) Dose in Childrens

Note: Dosing presented in mcg/kg, mg/kg, and mg/day. Use precaution.

Thiamine Dose in the treatment of Parenteral nutrition for maintenance requirement:

  • Infants:
    • In infants it is administered @ 0.35 to 0.5 mg/kg/day Intravenous to a maximum dose of 1.2 mg in 24 hrs.
  • Children:
    • 2 mg/day Intravenous.

Thiamine Dose in the treatment of Thiamine deficiency in critically ill patients (beriberi):

  • Infants:
    • Various regimens reported:
      • It is given 25 - 50 mg once intravenously, followed by 10 mg Intramuscular once daily for 7 days then 3 - 5 mg orally once daily for at least 6 weeks.
      • Other regimens with higher starting doses have also been reported.

Note: If mothers are breastfeeding then they should also be considered for thiamine deficiency treatment.​​​​​​​

  • Children: Insufficient data available:
    • 10 mg Intramuscular or Intravenous once daily initially for 7 days (if critically ill), then 3 to 5 mg orally once daily for at least 6 weeks.
  • Adolescents: Insufficient data available:
    • It can be given as 100 mg Intramuscular or Intravenous once daily for up to 7 days (if critically ill), then 10 mg orally once daily.

Pregnancy Risk Factor A

  • Water-soluble vitamins can cross the placenta. During pregnancy, Vitamin B1 is needed in greater quantities.
  • Due to prolonged nausea and vomiting, including hyperemesis gravidarum, pregnant women are at high risk of vitamin B1 deficiencies.
  •  Polyneuropathy and Wernicke encephalopathy can be signs of vitamin B1 deficiency.
  • Pregnant women with prolonged vomiting should take Vitamin B1 supplementation.
  • Wernicke Encephalopathy can be suspected by intravenous drug formulation. Depending on the severity of the condition, Intramuscular or oral therapy may be offered.
  • Infusing intravenous fluid to treat hyperemesis gravidarum should include thiamine. This will prevent Wernicke's encephalopathy.

Use during breastfeeding:

  • It is excreted from breastmilk. Vitamin B1 levels in breastmilk are similar between mothers who take supplements and those who don't.
  • Breastfeeding females require vitamin B1 in greater quantities. 
  • A deficiency in vitamin B1 may lead to infants exclusively breastfed who are not receiving enough. 
  • Supplementation should be provided to both mother and baby if there is a vitamin B1 deficiency.

Dose in Kidney disease:

  • No dosage adjustment provided in the manufacturer's labeling.

Dose in Liver disease:

  • No dosage adjustment provided in the manufacturer's labeling.

Side effects of Thiamine:

  • Central nervous system:
    • Flushing sensation
    • Restlessness
  • Dermatologic:
    • Diaphoresis
    • Pruritus
    • Skin sclerosis
    • Urticaria
  • Gastrointestinal:
    • Nausea
  • Hematologic & oncologic:
    • Hemorrhage (into the gastrointestinal tract)
  • Hypersensitivity:
    • Anaphylaxis
    • Angioedema
    • Hypersensitivity reaction
  • Local:
    • Tenderness at injection site
  • Neuromuscular & skeletal:
    • Weakness
  • Respiratory:
    • Cyanosis
    • Pharyngeal edema
    • Pulmonary edema

Contraindication to Thiamine ( Vitamin B1):

  • Allergy to thiamine and any component of the formulation

Warnings and Precautions​​​​​​​

  • Hypersensitivity reactions
    • Multiple parenteral doses have been linked to severe allergic reactions.
    • It is worth performing a skin test on people with history of allergic reactions.

Monitoring Parameters:

None required. Monitor for the symptomatic improvement.

How to administer Thiamine (Vitamin B1)?

Intramuscular and Intravenous:

  • The parenteral formulation can be given through the Intramuscular or Intravenous route. Various rates of administration have been described (e.g., 100 mg over 5 minutes).
  • The extended infusion time is chosen for doses greater than 100 mg. Local injection reactions can be decreased by slow administration over 30 minutes into larger & more proximal veins.
  • It should be given before giving parenteral glucose solutions to prevent the development of acute symptoms of thiamine deficiency in the malnourished.

Mechanism of action of Thiamine (Vitamin B1):

  • It is an essential coenzyme for carbohydrate metabolism. When combined with adenosine Triphosphate, it forms thiamine Pyrophosphate.
  • Thiamine can be used to treat ethylene glycol poisoning. It is thought that it will increase the formation glycine, which is a non-toxic metabolite.

Absorption It can be absorbed easily orally. It is easy to absorb intramuscularly.

Distribution: The highest concentrations are found in the brain, heart, kidney and liver

Metabolism Hepatic

Excretion: Urine (as an unchanged drug or as pyrimidine if body storage sites become saturated).

International Brand Names of Thiamine (Vitamin B1):

  • Betaxin
  • Thiamiject
  • Abery
  • Actamin
  • AFI-B
  • Aliaron D 10
  • Anerex
  • Aneurin-AS
  • Arcavit-B1
  • B1-ASmedic
  • B1-Vicotrat
  • Becaps
  • Benerva
  • Beneuran
  • Beneurol
  • Beneuron
  • Bermin B
  • Beta-Sol
  • Beta-Tabs
  • Betabion
  • Betamin
  • Betamine
  • Bevitine
  • Bevitol
  • Biogen
  • Dagravit B1
  • Dexabion
  • Hiace
  • Hithia
  • Incremin con Hierro
  • Kirin B1
  • Lophakomp-B1
  • Metabolin
  • Mutsutamin
  • Neo-Panlacticos
  • Neuramin
  • Pagavit
  • Pharmaton
  • Plivit B1
  • Suma-B
  • Thiamine Injection
  • Tiacur
  • Tiamidexal
  • Tiamin ”Dak”
  • Tiamina
  • Tiaminal
  • Tolima
  • Tribedoce
  • Trifosfaneurina
  • Tyvera
  • B1 Agepha
  • Vita-B1
  • Vitamin B1
  • Vitamin B1 Jenapharm
  • Vitamin B1 Kattwiga
  • Vitamin B1-Hevert
  • Vitamin B1Injektopas
  • Vitamin B1-ratiopharm
  • Vitamina B1 Biol
  • Vitaminum B1
  • Vitanon[inj.]

Thiamine (Vitamin B1) brand Names in Pakistan:

Tabs 100 mg

B-Compound Forte Ethical Laboratories (Pvt) Ltd.
Nevramin Helix Pharma (Private) Limited

Inj 100 mg/ml

Brucipin Shifa Laboratories.(Pvt) Ltd.
Nevramin Helix Pharma (Private) Limited
Thiamine Hydrochloride Shifa Laboratories.(Pvt) Ltd.

Dragees 100 mg

Benerva Bayer Health Care

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