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Thiamine
Pronunciation
Generic Available
Canadian Brand Names
Synonyms
Pharmacological Index
Use
Pregnancy Risk Factor
Contraindications
Warnings/Precautions
Adverse Reactions
Drug Interactions
Stability
Mechanism of Action
Pharmacodynamics/Kinetics
Usual Dosage
Dietary Considerations
Reference Range
Test Interactions
Mental Health: Effects on Mental Status
Mental Health: Effects on Psychiatric Treatment
Dental Health: Local Anesthetic/Vasoconstrictor Precautions
Dental Health: Effects on Dental Treatment
Patient Information
Nursing Implications
Dosage Forms
References

Pronunciation
(THYE a min)

Generic Available

Yes


Canadian Brand Names
Betaxin®; Bewon®

Synonyms
Aneurine Hydrochloride; Thiamine Hydrochloride; Thiaminium Chloride Hydrochloride; Vitamin B1

Pharmacological Index

Vitamin, Water Soluble


Use

Treatment of thiamine deficiency including beriberi, Wernicke's encephalopathy syndrome, and peripheral neuritis associated with pellagra, alcoholic patients with altered sensorium; various genetic metabolic disorders


Pregnancy Risk Factor

A/C (if dose exceeds RDA recommendation)


Contraindications

Hypersensitivity to thiamine or any component


Warnings/Precautions

Use with caution with parenteral route (especially I.V.) of administration


Adverse Reactions

<1%: Cardiovascular collapse and death, warmth, rash, angioedema, paresthesia


Drug Interactions

Neuromuscular blocking agents; high carbohydrate diets or I.V. dextrose solutions increase thiamine requirement


Stability

Protect oral dosage forms from light; incompatible with alkaline or neutral solutions and with oxidizing or reducing agents


Mechanism of Action

An essential coenzyme in carbohydrate metabolism by combining with adenosine triphosphate to form thiamine pyrophosphate


Pharmacodynamics/Kinetics

Absorption: Oral: Adequate; I.M.: Rapid and complete

Elimination: Renally as unchanged drug, and as pyrimidine after body storage sites become saturated


Usual Dosage

Recommended daily allowance:

<6 months: 0.3 mg

6 months to 1 year: 0.4 mg

1-3 years: 0.7 mg

4-6 years: 0.9 mg

7-10 years: 1 mg

11-14 years: 1.1-1.3 mg

>14 years: 1-1.5 mg

Thiamine deficiency (beriberi):

Children: 10-25 mg/dose I.M. or I.V. daily (if critically ill), or 10-50 mg/dose orally every day for 2 weeks, then 5-10 mg/dose orally daily for 1 month

Adults: 5-30 mg/dose I.M. or I.V. 3 times/day (if critically ill); then orally 5-30 mg/day in single or divided doses 3 times/day for 1 month

Wernicke's encephalopathy: Adults: Initial: 100 mg I.V., then 50-100 mg/day I.M. or I.V. until consuming a regular, balanced diet

Dietary supplement (depends on caloric or carbohydrate content of the diet):

Infants: 0.3-0.5 mg/day

Children: 0.5-1 mg/day

Adults: 1-2 mg/day

Note: The above doses can be found in multivitamin preparations

Metabolic disorders: Oral: Adults: 10-20 mg/day (dosages up to 4 g/day in divided doses have been used)


Dietary Considerations

High carbohydrate diets may increase thiamine requirement


Reference Range

Therapeutic: 1.6-4 mg/dL


Test Interactions

False-positive for uric acid using the phosphotungstate method and for urobilinogen using the Ehrlich's reagent; large doses may interfere with the spectrophotometric determination of serum theophylline concentration


Mental Health: Effects on Mental Status

None reported


Mental Health: Effects on Psychiatric Treatment

None reported


Dental Health: Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions


Dental Health: Effects on Dental Treatment

No effects or complications reported


Patient Information

Take exactly as directed; do not discontinue without consulting prescriber (deficiency state can occur in as little as 3 weeks). Follow dietary instructions (dietary sources include legumes, pork, beef, whole grains, yeast, fresh vegetables).


Nursing Implications

Single vitamin deficiency is rare; look for other deficiencies


Dosage Forms

Injection, as hydrochloride: 100 mg/mL (1 mL, 2 mL, 10 mL, 30 mL); 200 mg/mL (30 mL)

Tablet, as hydrochloride: 50 mg, 100 mg, 250 mg, 500 mg

Tablet, as hydrochloride, enteric coated: 20 mg


References

Doyon S and Roberts JR, "Reappraisal of the "Coma Cocktail": Dextrose, Flumazenil, Naloxone, and Thiamine," Emerg Med Clin North Am, 1994, 12(2):301-16.

Hoffman RS and Goldfrank LR, "The Poisoned Patient With Altered Consciousness. Controversies in the Use of a 'Coma Cocktail'," JAMA, 1995, 274(7):562-9.

Petrie WM and Ban TA, "Vitamins in Psychiatry. Do They Have a Role?" Drugs, 1985, 30(1):58-65.

Proebstle TM, Gall H, and Jugert FK, "Specific IgE and IgG Serum Antibodies to Thiamine Associated With Anaphylactic Reaction," J Allergy Clin Immunol, 1995, 95(5 Pt 1):1059-60.

Reuler JB, Girard DE, and Cooney TG, "Current Concepts: Wernicke's Encephalopathy," N Engl J Med, 1985, 312(16):1035-39.

Stephen JM, Grant R, and Veh CS, "Anaphylaxis From Administration of Intravenous Thiamine," Am J Emerg Med, 1992, 10(1):61-3.

Van Haecke P, Ramaekers D, Vanderwegen L, et al, "Thiamine-Induced Anaphylactic Shock," Am J Emerg Med, 1995, 13(3):371-2.

Wrenn KD, Murphy F, and Slovis CM, "A Toxicity Study of Parenteral Thiamine Hydrochloride," Ann Emerg Med, 1989, 18(8):867-70.


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