NHS England (NHSE) has published new prescribing guidance for items of limited clinical effectiveness that should not be routinely prescribed in primary care (quick reference guide). This included vitamins and minerals, unless there is a medically diagnosed deficiency, or when using calcium and vitamin D for osteoporosis, or for treating malnutrition including alcoholism. The guidance also excludes patients suitable to receive Healthy Start vitamins.

Many vitamin products are cheap to buy and are readily available over the counter along with advice from pharmacies. Some self-care medicines are available from shops and supermarkets. Please click here for further information, exceptions, and a patient leaflet.

See also section 4.10 Drugs used in substance dependence

Thiamine (vitamin B1)

• Tablets 50mg, 100mg (£3.33 = 100 x 100mg tablets)
• Injection 250mg in 5ml (unlicensed preparation)

Indications

• Assisted alcohol withdrawal
• Maintenance treatment following alcohol withdrawal

Notes

1. NICE CG100 recommend that patients undergoing alcohol detoxification in the community should receive oral doses of thiamine at doses approaching the "upper end" of the BNF range. The British Association of Psychopharmacology (BAP) recommend "oral thiamine greater than 300mg/day" during detoxification.

Vitamin B Compound Strong

• Tablets containing nicotinamide 20mg, pyridoxine 2mg, riboflavine 2mg, thiamine 5mg (£6.30 = 2 three times a day)

Pyridoxine (vitamin B6)

• Tablets 10mg, 20mg, 50mg (£47.19 = 50mg three times daily)
• Injection 100mg/2ml (unlicensed preparation) For use in University Hospitals Plymouth NHS Trust

Indications and dose

• Deficiency states
  • 20–50mg up to 3 times daily
• Isoniazid-induced neuropathy
  • Prophylaxis: 10mg daily
  • Treatment: 50mg three times daily
• Idiopathic sideroblastic anaemia

Pabrinex Intramuscular High Potency

• Solution for injection

Notes

1. For intramuscular use only
2. Each presentation (carton) contains pairs of 5 ml and 2 ml ampoules.
3. Each pair of ampoules consists of one 5 ml and one 2 ml ampoule to be used in treatment, labelled as Pabrinex No. 1 and Pabrinex No. 2.
   1. Each 5ml Pabrinex No 1 ampoule contains pyridoxine hydrochloride 50mg, riboflavin 4mg, and thiamine hydrochloride 250mg
   1. Each 2ml Pabrinex No 2 ampoule contains ascorbic acid 500mg and nicotinamide 160mg
4. Certain vulnerable categories of patients should receive parenteral thiamine for the prevention of Wernicke-Korsokoff syndrome (WKS) but, due to the small risk of serious allergic reactions, this should only occur where facilities for treating anaphylaxis are available.

Pabrinex Intravenous High Potency

• Concentrate for solution for infusion

Notes

1. For intravenous use only
2. Each presentation (carton) contains either 5 ml or 10 ml ampoules. Each pair of ampoules to be used in treatment is labelled Pabrinex No 1 and Pabrinex No 2.
   1. Each 5ml Pabrinex No 1 ampoule contains pyridoxine hydrochloride 50mg, riboflavin 4mg, and thiamine hydrochloride 250mg
   2. Each 5ml Pabrinex No 2 ampoule contains ascorbic acid 500mg, anhydrous glucose 1g, and nicotinamide 160mg
   3. Each 10ml Pabrinex No 1 ampoule contains pyridoxine hydrochloride 100mg, riboflavin 8mg, and thiamine hydrochloride 500mg
   4. Each 10ml Pabrinex No 2 ampoule contains ascorbic acid 1g, anhydrous glucose 2g, and nicotinamide 320mg
3. Certain vulnerable categories of patients should receive parenteral thiamine for the treatment of Wernicke-Korsokoff syndrome (WKS) but, due to the small risk of serious allergic reactions, this should only occur where facilities for treating anaphylaxis are available.