Key points
- We recommend to consult your poison centre with the use of this antidote.
- Concomitant administration of dextrose is indicated when capillary blood glucose is less than 4 mmol/L.
- It is not necessary to delay dextrose administration in patients presenting symptomatic hypoglycemia in order to administer the first dose of thiamine.
+ Synonyms and other terms
- Betaxin®
- Thiamiject®
- Vitamin B1
+ Indications
- Adjuvant in the treatment of ethylene glycol poisoning (conversion of glyoxylate alpha-hydroxy-beta-ketoadipate).
+ Dosage
+ Pediatric Dose
- 50 mg direct IV every 8 hrs.
+ Adult Dose
- 100 mg direct IV every 8 hrs.
+ Renal Impairment
No data suggests that the dose should be modified for short-term use.
+ Hepatic Impairment
No data suggests that the dose should be modified for short-term use.
+ Hemodialysis Patient
No data suggests that the dose should be modified for short-term use.
+ Pregnancy
- The safety of large doses has not been established.
- Nonetheless, do not hesitate to use thiamine during pregnancy if the expected toxic effects pose a significant risk of morbidity or mortality.
- No data suggests that the dose should be modified for short-term use.
+ Obese or Overweight Patient
No data suggests that the dose should be modified for short-term use.
+ Adverse effects
- During rapid intravenous administration: anaphylactoid reaction, vasodilation, hypotension, weakness, angioedema.
+ Monitoring
- Monitor adverse effects.
+ End of treatment
- Adjuvant in the treatment of ethylene glycol poisoning: after 24 hrs of administration.
+ Special Notes on Administration
Intravenous Route (IV)
- Direct IV:
- Preferred route.
- Dilute the dose with 10 ml of NS.
- Administer IV over 5 min.
Subcutaneous Route (SC)
- No data available.
Intramuscular Route (IM)
- Alternative if administration by IV route is impossible.
Intraosseous Route (IO)
- No data available.
Compatibility
Partial list only. Consult the pharmacist on duty at your health care facility.
- Compatible solutes: D5W, ½NS, NS, LR.
- Y-site compatibility: alfentanil, atracurium, atropine, aztreonam, benztropine, bretylium, calcium (chloride and gluconate), chlorpromazine, cimetidine, cyclosporine, dexamethasone, digoxin, diphenhydramine, dobutamine, dopamine, epinephrine, esmolol, famotidine, fentanyl, glycopyrrolate, heparin, regular insulin isoproterenol, labetalol, lidocaine, magnesium (sulfate), mannitol, meperidine, metoclopramide, metoprolol, morphine, MVI, naloxone, nitroglycerin, sodium nitriprussiate, norepinephrine, penicillin G (sodium and potassium), pentamidine, phentolamine, phenylephrine, phytonadione (vitamin K1), potassium (chloride), procainamide, prochlorperazine, promethazine, propranolol, protamine, pyridoxine, quinidine, ranitidine, succinylcholine, sufentanil, theophylline, vasopressin, verapamil.
- Y-site incompatibility:aminophylline, sodium bicarbonate, dantrolene, diazepam, folic acid, furosemide, haloperidol, hydralazine, methylprednisolone, pentobarbital, phenobarbital, phenytoin.
Stability
- The diluted solution is stable for 24 hrs.
- Thiamine is unstable in neutral or alkaline solutions. Do not use in combination with alkaline solutions (e.g. carbonate, citrate, barbiturates, acetates, copper ions).
- Solutions containing sulfites are incompatible with thiamine as are other oxidizing and reducing agents.
+ Available products
- Thiamiject, 100 mg/ml, Inj. Sol., 10 ml vial, Omega, DIN 02193221,
- Vitamin B1, 100 mg/ml, Inj. Sol., vial of 1 and 10 ml, Sandoz/Baxter, DIN 00816078,
+ Amount required to treat a person weighting 70kg during 24 hours
- At least 300 mg.
+ References
Aleguas, Alfred, Jr. 2016. “Thiamine.” In Critical Care Toxicology, edited by Jeffrey Brent, Keith Burkhart, Paul Dargan, Benjamin Hatten, Bruno Megarbane, and Robert Palmer, 1–7. Springer International Publishing.
Frank, Laura L. 2015. “Thiamin in Clinical Practice.” JPEN. Journal of Parenteral and Enteral Nutrition 39 (5):503–20.
Schabelman, Esteban, and Dick Kuo. 2012. “Glucose before Thiamine for Wernicke Encephalopathy: A Literature Review.” The Journal of Emergency Medicine 42 (4):488–94.
Sivilotti, Marco L. A. 2016. “Flumazenil, Naloxone and the ‘coma Cocktail.’” British Journal of Clinical Pharmacology 81 (3):428–36.
