High-dose thiamine as IV push safe to administer

Administering thiamine ≤200 mg as an intravenous (IV) push is safe, with no serious adverse events (AEs) seen, reveals a study.

Earlier studies reported increased incidence of infusion-related reactions when administering thiamine at doses >100 mg as an IV push. To assess the safety of administering higher IV push doses compared to infusion, the investigators performed a single-centre, retrospective review from June to October 2017, including patients aged ≥18 years who received one dose of IV thiamine ≥200 mg.

Patients were then divided into two groups: group 1 included those who received 200-mg IV push and group 2 those receiving any dose >200 mg. The investigators quantified and compared the rate of adverse reactions between groups. They also examined institutional thiamine prescribing practices, as well as performed Wilcoxon Rank Sum and Fischer exact tests.

Of the patients (median age 55 years [interquartile range, 44–63 years], 66 percent male), 50 percent received 200-mg IV push, 20 percent received a combination of IV infusion and IV push, and 30 percent received IV infusion.

Adverse reactions potentially related to thiamine administration were noted in four patients (2.0 percent): one patient received 200-mg IV infusion, while the rest received 200-mg IV push. No significant difference was observed in adverse reaction rate between IV push and IV infusion administrations (p=0.640).

“Our results support administering thiamine doses of 200 mg or less as an IV push,” the investigators said. “Given lack of robust safety data, it is recommended to continue to dilute doses greater than 200 mg and infuse over 30 minutes.”