ATTRACT cannot make recommendations for doses in individual patients. However, Prodigy guidance on alcohol � problem drinking (1) makes the following recommendations.

�When should I recommend vitamin B supplements?

Vitamin B supplements in chronic deficiency

People with chronic alcohol dependence are frequently malnourished and deficient in vitamins, especially thiamine, largely because of reduced absorption.

The SIGN guideline recommends that people who have a chronic alcohol problem and whose diet may be deficient should be given oral thiamine indefinitely (GPP).

There is limited evidence for recommending a dosage of thiamine in the treatment of alcohol dependence. The BNF recommended dose is:

�        Severe deficiency: 200-300 mg per day. This should be given in divided doses to maximize absorption.

�        Mild chronic deficiency: 10-25 mg per day.

Vitamin B supplements during detoxification

Detoxification may precipitate Wernicke's encephalopathy, which must be treated urgently with parenteral thiamine. Signs of possible Wernicke-Korsakoff syndrome (which may progress to encephalopathy) in someone undergoing detoxification include:

Confusion

Ataxia

Ophthalmoplegia

Nystagmus

Memory disturbance

Hypothermia and hypotension

Coma

Anyone who presents with unexplained neurological signs or symptoms should be referred for specialist assessment.

Anyone undergoing alcohol detoxification at home should be given oral thiamine (200 mg daily) for 5-7 days.

People who are severely malnourished or have long-standing dependence are at highest risk of developing clinical manifestations of thiamine deficiency during alcohol withdrawal. There is a strong argument for admitting such at-risk people to hospital during detoxification for parenteral administration of vitamin supplements (Pabrinex)�.

1.  http://www.prodigy.nhs.uk/guidance.asp?gt=Alcohol%20-%20problem%20drinking