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Vitamins B&C Kyowa Kirin Intravenous High Potency, Concentrate for Solution for Infusion
RESOURCES
Vitamins B&C Kyowa Kirin Intravenous High Potency, Concentrate for Solution for Infusion (Vitamins B&C Kyowa Kirin IVHP) is a parenteral therapy for rapid treatment of severe depletion or malabsorption of the water soluble vitamins B and C, including those related to alcohol misuse and malnutrition.1
Adverse Events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard. Adverse Events should also be reported to Kyowa Kirin International UK NewCo Ltd, known as Grünenthal Meds on +44 (0)1896 664000, email PVUK@grunenthalmeds.com
Click here for prescribing information.
Guidance and recommendations
NICE2
NICE guidance recommends parenteral thiamine for Wernicke’s encephalopathy (WE).
Keep a high level of suspicion for WE and treat for a minimum of 5 days, unless WE is excluded, if the patient is:
NICE recommends treatment at the upper end of the BNF dose range, which is Vitamins B&C Kyowa Kirin IVHP IV, 2-3 pairs, 3 times a day.2,3
BNF3
BNF recommends for the treatment of suspected or established Wernicke’s encephalopathy: Vitamins B&C Kyowa Kirin IVHP IV, 2-3 pairs of ampoules, 3 times a day, for 3-5 days, followed by 1 pair, once daily, for a further 3-5 days or for as long as improvement continues.
RCEM4
The Royal College of Emergency Medicine (RCEM) toolkit recommends parenteral thiamine in: suspected Wernicke’s encephalopathy; the intoxicated; those with symptoms that could mask WE; or, those at risk of WE.
In the Emergency Department, infuse Vitamins B&C Kyowa Kirin IVHP IV 2 pairs at once; then on transfer to CDU, infuse 2 pairs 3 times a day. In those at high risk likely to be referred onward, infuse 2 pairs 3 times a day for 5 days.
BSG5
The British Society of Gastroenterology (BSG) recommends that for patients with decompensated liver disease and a history of current excess alcohol consumption, Vitamins B&C Kyowa Kirin IVHP IV should be administered at a dose of 2-3 pairs, 3 times a day.
Cost savings information
Not only can delayed or inadequate treatment of suspected or established WE potentially cause debilitating and long-term ARBD, it can also increase the long-term costs of caring for that patient:
Special residential costs for each patient with ARBD is over £40,000 per year.7
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References
1. Vitamins B&C Kyowa Kirin Intravenous High Potency, Concentrate for Solution for Infusion Summary of Product Characteristics.
2. National Institute for Health and Care Excellence. Full Guidance June 2010. (Updated April 2017). Alcohol use disorders and clinical management of alcohol-related physical complications [Clinical Guidance 100].
3. Vitamin B substances with ascorbic acid. British National Formulary. https://bnf.nice.org.uk/drugs/vitamin-b-substances-with-ascorbic-acid/ Last accessed June 2024.
4. Royal College of Emergency Medicine. Alcohol: A toolkit for improving care. June 2015.
5. British Society of Gastroenterology. Decompensated Cirrhosis Care Bundle – First 24 Hours. Available at: https://www.bsg.org.uk/clinical-resource/bsg-basl-decompensated-cirrhosis-first-24-hours. Last accessed: June 2024.
6. Wilson CF, et al. Appl Health Econ Health Policy. Published Online December 2015.
7. Evidence-based profile of alcohol related brain damage in Wales. Public Health Wales 2015.
KKI/GB/PAB/0263 June 2024