Due to the long-term supply issue with Pabrinex, CHFT will switch to using IV thiamine this Wednesday, 2nd October 2024

Information for prescribers:

• EPR order sentences will start to change on Cerner at 07:00 on 2nd October and may take around two hours to complete
  • Pabrinex order sentences will be removed from powerplan
  • Thiamine order sentences added to powerplan
• From this date, patients already started on Pabrinex will complete the prescribed Pabrinex course. New patients will be started on IV thiamine
• IV thiamine is an unlicensed medicine, but updated guidance has been approved by MMC and is available at Calderdale and Huddersfield (cht.nhs.uk)
• Dosage information for IV thiamine is as follows (information embedded in EPR order sentences)
  • Alcohol withdrawal – treatment of Wernicke’s encephalopathy
    • 500mg IV thiamine THREE times a day for 3 days, followed by either prophylactic IV thiamine dose or oral thiamine
  • Alcohol withdrawal – prophylaxis for Wernicke’s encephalopathy
    • 300mg IV thiamine ONCE a day for 5 days, followed by oral thiamine
  • Refeeding syndrome (use oral route if available)
    • 300mg IV thiamine ONCE a day for 3 days (extend course to 5 days for high risk patients)
• IV thiamine doses to be diluted in 50mL to 100mL sodium chloride 0.9%
• Information for the brand being used (Vitamin B1 – Injektopas®) is available on Medusa

One ampoule of Pabrinex contains 250mg thiamine.

One ampoule of unlicensed Injektopas® contains 100mg/2mL of thiamine.

Further information can be found on the Royal College of Emergency Medicine safety flash at Pabrinex_Shortage_Safety_Flash_August_2024_v1.pdf (rcem.ac.uk)

If you have any questions about the switch, please contact your ward pharmacist or Pharmacy Medicine Information Service (CRH 4356).