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 4.10 Drugs used in substance dependence

Thiamine (vitamin B1)

• Tablets 50mg, 100mg (£3.33 = 100 x 100mg tablets)

Indications

• Assisted alcohol withdrawal
• Maintenance treatment following alcohol withdrawal

Pyridoxine (vitamin B6)

• Tablets 10mg, 20mg, 50mg (£47.19 = 50mg three times daily)
• Injection (unlicensed)

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

Notes

1. Pyridoxine may also given in high doses for hyperoxaluria.

Vitamin B Compound Strong

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

Indications

• For use in patients requiring additional nutritional support, for example eating disorders, poor oral intake and patients at risk of refeeding syndrome
• Vitamin B compound strong is no longer recommended in the treatment of alcohol withdrawal

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. 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
   2. Each 2ml Pabrinex No 2 ampoule contains ascorbic acid 500mg and nicotinamide 160mg

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