Pabrinex (Vitamins B and C) Intravenous for Adults

Who can administer

May be administered by registered competent doctor or nurse/midwife

Important information

Global shortage of Pabrinex for 16 months from April 2024 Please follow guidelines below with regard to doses
Stock available	Pharmacy (location I11/STJ)
	Emergency Department Zone B (controlled drug press - to be signed out of Pabrinex stock register)

• Two formulations available - one for IV one for IM use (IM preparation not routinely stocked in UCH). Please ensure the correct formulation is being used for the required route.
• Facilities for treating anaphylaxis should be available when administering this preparation

Available preparations

Pabrinex IV (2 ampoules) 2 x 5ml ampoules

Ampoule No. 1 contains	Ampoule No. 2 contains
Thiamine Hydrochloride Ph. Eur. 250mg Riboflavine (as Phosphate Sodium BP) 4mg Pyridoxine Hydrochloride Ph. Eur. 50mg	Ascorbic Acid Ph. Eur. 500mg Nicotinamide Ph. Eur. 160mg Anhydrous Glucose Ph. Eur. 1g

Reconstitution

Already in solution

Draw up using a 5 micron filter needle

Infusion fluids

Sodium chloride 0.9% or Glucose 5%

Methods of intravenous administration

Intermittent intravenous infusion (administer using an electronically controlled infusion device)

• Equal volumes of the contents of ampoules no. 1 and 2 should be added to 100mL infusion fluid
• Administer over 30 minutes
• Up to three pairs of ampoules may be added to 100mL bag
• A 50mL infusion may be used if required (eg fluid restriction) but the residual volume in the infusion line must be flushed through at the same rate to avoid significant underdosing

Dose in adults

Prophylaxis of Wernicke's Encephalopathy associated with alcohol-use disorders ^{(ref 1)}

• Give one pair of ampoules once a day for 3 days
• Then switch to oral thiamine 100 to 300mg daily, continued until patient is no longer at risk

Treatment of Suspected or Established Wernicke's Encephalopathy ^{(ref 1)}

• Give one or two pairs* of ampoules three times a day for at least 5 days - and continue until no further improvement in signs and symptoms, or Wernicke's encephalopathy has been excluded
• Then switch to oral thiamine 100 to 300mg daily, continued until patient is no longer at risk
• * one pair if NO alcohol dependence, two pairs if alcohol dependence

Refeeding syndrome ^{(ref 1)}

• Pabrinex should only be used for patients with intestinal failure at high risk or extremely high risk of refeeding syndrome where the oral or enteral route is unavailable
• Give one pair once daily for 3 days (5 days for higher-risk patients)

Storage

• Store below 25⁰C

References

SPC November 2018

1: HSE recommendations for Pabrinex and thiamine prescribing due to international supply disruption July 2024

Therapeutic classification

Multivitamin preparations