Thiamine

Registered South African indications:

• Thiamine deficiency

Contraindications

• Hypersensitivity to the active ingredient or any of its excipients  

Cautions

• Pregnancy (if doses > recommended daily allowance)
• Galactose intolerance (tab)
• Lapp lactase deficiency (tab)
• Glucose-galactose malabsorption (tab)  

Forms avail. in SA and covered in this monograph: tab, inj

Thiamine deficiency with peripheral neurology or cardiac failure
Alcohol-induced hepatitis
Beri-beri
Ethylene glycol poisoning (Additional agent required)

• Oral (tab): 100mg, dly

Ethanol poisoning

• IV: 100mg in 1000ml 5% dextrose

Prophylaxis of permanent neurological damage in patients at risk of thiamine deficiency receiving glucose-containing fluids 

• IM/ Oral (tab): 300mg, dly

Alcohol withdrawal syndrome

• Oral (tab): 300mg, dly; Treatment duration: 14 days

Alcoholics with hypoglycaemia
Malnourished with hypoglycaemia

• IV/IM: 100mg immediately

Wernickes syndrome

• IV: 500mg, 12hrly; Treatment duration: 3 days
  THEN
• IV: 500mg, dly; Treatment duration: 3-5 days
  THEN
• Oral (tab): 100mg, 8hrly

Thiamine should preferably be administered prior to intravenous glucose to prevent permanent neurological damage

Paed. forms avail. in SA and covered in this monograph: tab, inj

Thiamine deficiency with peripheral neurology or cardiac failure
Prophylaxis of thiamine deficiency

• Oral (tab): 10-50mg/day, in divided doses

Beri-beri

Critically ill

• IV/IM: 10-25mg, dly

Not critically ill

• Oral (tab): Initial: 10-50mg, dly for 2 weeks; Maintenance: 5-10mg, dly; Treatment duration: 1 month

Pregnancy

• Safe
• Generally acceptable at doses of the recommended daily allowance. Thiamine, at doses above the recommended daily allowance, is only recommended for use during pregnancy when benefit outweighs risk

Breastfeeding

• Compatible
• Thiamine is present in breast milk. The requirement for thiamine is increased in breastfeeding mothers. Thiamine deficiency in breastfeeding mothers may lead to a deficiency in exclusively breastfed infants

Renal Impairment

• No dose adjustment recommended

Hepatic Impairment

• No dose adjustment recommended

Elderly

• No dose adjustment recommended

Porphyria Information

• Not porphyrinogenic (NP)

Drugs in Sport

• Permitted - No warnings

Gastrointestinal Disorders 

• Nausea and vomiting
• Diarrhoea
• Abdominal pain  

Immune Disorders

• Allergic reactions
• Anaphylactic reactions

• Thiosemicarbazone
• 5-Fluorouracil  

None routine

Thiamine pyrophosphate (TPP), the coenzymatic form of thiamine, is involved in decarboxylation of alpha-ketoacids and transketolation. Therefore, the main physiological role of thiamine is as a coenzyme in carbohydrate metabolism, where TPP is required for several stages in the breakdown of glucose to provide energy. Thiamine also plays a role in neurotransmitter function and in nerve conduction. In high doses, thiamine suppresses the transmission of neural stimuli and thus can have an analgesic effect.

Thiamine is available in several formulations. Please note the list below gives examples of products which are available and is not necessarily comprehensive. The listing of a product does not constitute endorsement of the product by EMGuidance; likewise, failure to list a product does not imply that EMGuidance disapproves of the product. This information is put together on the basis of the National Government's Medicines Price Registry at the time of publication

Tablet 100mg

• Lennon Thiamine Hydrochloride (Pharmacare)
• Litha-Thiamine (Litha)
• Portfolio Thiamine (Portfolio)
• Vit B1(Adcock)

Injection (per 1ml) 100mg

• Lennon Thiamine Hydrochloride (Litha)