ascorbic acid + glucose monohydrate + nicotinamide + pyridoxine + riboflavin + thiamine: clinical use

Prescribing considerations

• Reserve parenteral replacement for situations requiring this route; oral thiamine absorption can be inadequate in severe alcohol-related depletion or malnutrition.
• Use intravenously only after dilution, with trained staff and facilities for treating anaphylaxis immediately available.
• Do not let the rare allergy risk delay essential parenteral thiamine when Wernicke’s encephalopathy is a concern.
• Consider sodium content where sodium restriction is clinically important.

Contraindications and cautions

• Hypersensitivity to any active ingredient or excipient.
• Exercise particular caution after sneezing, bronchospasm or another suspected hypersensitivity response to previous parenteral thiamine or this combination.

Monitoring

• Observe during and shortly after administration for hypersensitivity, hypotension and infusion-site reactions.
• Monitor clinical response, including neurological features where thiamine deficiency or Wernicke’s encephalopathy is suspected.
• No product-specific routine laboratory monitoring schedule is specified.

Clinical pharmacology

A parenteral combination of thiamine, riboflavin, pyridoxine, nicotinamide and ascorbic acid with glucose. It replenishes cofactors required for energy metabolism and neurological function while bypassing gastrointestinal absorption.

Formulation and product differences

• The intravenous concentrate is supplied as paired amber-glass ampoules: one contains B vitamins and the other contains ascorbic acid, nicotinamide and glucose.
• Equal volumes from the paired ampoules are combined and diluted before infusion.
• Do not mix with medicines or fluids unless compatibility is established in the product information. Protect from light and do not freeze.