Vitamin B1 (thiamine) combines with ATP to form a coenzyme , thiamine pyrophosphate ( thiamine diphosphate , cocarboxylase) , which is necessary for carbohydrate metabolism.

Prevention and treatment of thiamine deficiency states. Deficiency of thiamine may lead to beriberi (dry or wet ) or Wernicke’s encephalopathy . Requirements may be increased and /or supplementation may be necessary in the following persons or conditions : burns , chronic fever , gastrectomy , chronic hemodialysis , hepatic – biliary tract disease (alcoholism with cirrhosis , hepatic function impairment) , hyperthyroidism , prolonged infection , intestinal disease (celiac , ileal resection , topical sprue , regional enteritis) , persistent diarrhea , heavy manual labor for long periods of time , prolonged stress , patients receiving TPN or undergoing rapid weight loss or in those with malnutrition , pregnancy , breast – feeding period , treatment of subacute necrotizing encephalomyelopathy , treatment of maple syrup urine disease , treatment of pyruvate carboxylase deficiency , treatment of hyperalaninemia.

Incidence rare – Anaphylactic reaction including coughing , difficulty in swallowing , hives , itching , swelling of face , lips , or eyelids , wheezing or difficulty in breathing , cardiovascular collaps ( usually after a large IV dose) ; paresthesia.

Hypersensitivity to thiamine or any component of the formulation.

IV glucose loading may precipitate or worsen wernicke’s encephalopathy in thiamine –deficient patients ; thiamine should be administered prior to glucose.

Neuromuscular blocking agents

High carbohydrate diets may increase thiamine requirement.

• Usual adult and adolescent dose: Deficiency (prophylaxis) – Oral , amount based on normal daily recommended intakes :
  
  

  Persons	mg
  Adolescent and adult males	1.2 - 1.5
  Adolescent and adult females	1- 1.1
  Pregnant females	1.5
  Breast – feeding females	1.6

  
  Deficiency (treatment ) – Treatment dose is individualized by prescriber based on severity of deficiency . The following dosage has been established : Beriberi (initial in mild or maintenance following severe) –Oral , 5 to 10 mg three times a day.
  Genetic enzyme deficiency diseases – Oral , 10 to 20 mg per day as a single dose (dosage of up to 4 grams per day in divided doses has been used) .
• Usual pediatric dose: Deficiency (prophylxis) – Oral , amount based on intake of normal daily recommended intakes :
  
  

  Persons	mg
  Birth to 3 years of age	0.3 - .0.7
  4 to 6 years of age	0.9
  7 to 10 years of age	1

  
  Deficiency (treatment) – Treatment dose is individualized by prescriber based on severity of deficiency . The following dosage has been established : Beriberi(mild) – Oral , 10 mg per day.

• USP DI, 2004
• Up To Date, Vol. 13.1 (2005)
• Martindale, The Complete Drug Reference, 33 rd edition 2002