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Thiamine (Monograph)

Drug class: Vitamin B Complex
VA class: VT105
Chemical name: thiazolium,3- [(4-amino-2-methyl-5-pyrimidinyl)methyl]-5-(2-hydroxyethyl)-4-methyl-chloride, monochloride
CAS number: 67-03-8


Water-soluble, B complex vitamin.

Uses for Thiamine

Thiamine Deficiency

Treatment of thiamine deficiency syndromes (e.g., beriberi, Wernicke’s encephalopathy syndrome).

Dietary Requirements

Adequate intake needed to prevent thiamine deficiency (beriberi).

Adequate thiamine intake can be accomplished through consumption of foodstuffs. Enriched, fortified, or whole grain products; bread and bread products; mixed foods with grain as a main ingredient; and ready-to-eat cereals are the major contributors of thiamine in the diet of US adults and children.

Recommended Dietary Allowance (RDA) in adults based on erythrocyte transketolase activity, urinary thiamine excretion, and other findings.

Requirements slightly lower in women than men based on women's size and average energy utilization.

Adequate intake (AI) established for infants ≤6 months of age based on observed mean thiamine intake of infants fed principally human milk; AI for infants 7–12 months of age based on AI for younger infants and data in adults.

RDA for children 1–18 years of age based on data in adults.

Metabolic Disorder

Has been used in thiamine-responsive maple syrup urine disease [off-label] and subacute necrotizing encephalomyelopathy [off-label] (Leigh's disease).

Thiamine Dosage and Administration


Usually administered orally. May be administered by IV or IM injection when indicated or when oral administration is not feasible.

For solution and drug compatibility information, see Compatibility under Stability.


Available as thiamine hydrochloride; dosage expressed in terms of the salt.

Pediatric Patients

Thiamine Deficiency

Noncritically ill children: 10–50 mg daily, given in divided doses.

IM or IV

Critically ill children (e.g., infantile beriberi): 10–25 mg.

Dietary and Replacement Requirements

Infants ≤6 months of age: Recommended AI is 0.2 mg (0.03 mg/kg) daily.

Infants 7–12 months of age: Recommended AI is 0.3 mg (0.03 mg/kg) daily.

Children 1–3 years of age: RDA is 0.5 mg daily.

Children 4–8 years of age: RDA is 0.6 mg daily.

Children 9–13 years of age: RDA is 0.9 mg daily.

Boys 14–18 years of age: RDA is 1.2 mg daily.

Girls 14–18 years of age: RDA is 1 mg daily.

RDAs not expected to meet the needs of those with malabsorption syndrome or undergoing hemodialysis or peritoneal dialysis.


Thiamine Deficiency

Noncritically ill adults: 5–30 mg daily, as a single dose or 3 divided doses, for 1 month.

IV followed by IM

Wernicke's syndrome: Initially 100 mg IV, followed by 50–100 mg IM daily until patient can consume a balanced diet.

IV or IM

Critically ill thiamine-deficient adult or patient with malabsorption syndrome: 5–100 mg 3 times daily.


Beriberi: 10–20 mg 3 times daily for up to 2 weeks.

Dietary and Replacement Requirements

Men ≥19 years of age: RDA is 1.2 mg daily.

Women ≥19 years of age: RDA is 1.1 mg daily.

RDAs not expected to meet the needs of those with malabsorption syndrome or undergoing hemodialysis or peritoneal dialysis.

Prescribing Limits

Single doses >30 mg not likely to be utilized.

Special Populations

Pregnant Women

RDA for pregnant women is 1.4 mg daily.

Thiamine intake >1.4 mg daily needed by women who are pregnant with >1 fetus.

Requirements increased in pregnant women to cover increased energy utilization and growth in the maternal and fetal compartments.

Lactating Women

RDA for lactating women is 1.5 mg daily.

Thiamine intake >1.5 mg daily needed by women who are nursing >1 infant.

Requirements increased in lactating women to ensure adequate concentration of the vitamin in milk.

Cautions for Thiamine


Known sensitivity to thiamine or any ingredient in formulation.


Sensitivity Reactions

Hypersensitivity Reactions

Possible severe hypersensitivity reactions/anaphylaxis, especially following repeated parenteral administration.

Skin Test

Administer an intradermal test dose prior to parenteral administration of therapeutic doses of thiamine in patients who may be sensitive to the drug.

General Precautions

Aluminum Content

Some thiamine hydrochloride injection preparations contain aluminum, which may be toxic. Aluminum may reach toxic levels with prolonged parenteral administration if kidney function is impaired. Premature neonates are particularly at risk because their kidneys are immature, and they require large amounts of calcium and phosphate solutions, which contain aluminum.

Research indicates that patients with impaired kidney function, including premature neonates, who receive aluminum parenterally in quantities of >4–5 mcg/kg daily accumulate aluminum at levels associated with CNS and bone toxicity. Tissue loading may occur at even lower rates of administration.

Specific Populations


Category A.


Distributed into milk. Caution if parenteral preparation is used in nursing women.

Common Adverse Effects

Relatively nontoxic; feelings of warmth, pruritus, urticaria, weakness, sweating, nausea, restlessness, angioedema, tightness in the throat, cyanosis, pulmonary edema, GI bleeding reported with parenteral administration.

Drug Interactions

Specific Drugs and Laboratory Tests




Neuromuscular blocking agents

Possible enhanced neuromuscular blocking action

Clinical importance unknown

Schack and Waxler determination of serum theophylline concentrations

Large doses of thiamine may interfere with this test

Test for uric acid

Possible false-positive result with the phosphotungstate method

Test for urobilinogen using Ehrlich's reagent

Possible false-positive result

Thiamine Pharmacokinetics



Small doses are readily absorbed from the GI tract.

Completely absorbed following IM administration.


Rate, but not extent, of GI absorption is decreased when administered with meals.



Distributed into all tissues; highest concentrations in liver, brain, kidney, and heart.


Elimination Route

Excreted in urine as unchanged drug and metabolites.





Tight, light-resistant container at <40°C; preferably between 15–30°C.



20–25°C. Protect from light.



Solution CompatibilityHID


Dextran 6% in dextrose 5%

Dextran 6% in sodium chloride 0.9%

Dextrose–Ringer's injection combinations

Dextrose-Ringer’s injection, lactated, combinations

Dextrose-saline combinations

Dextrose 2½, 5, or 10% in water

Fat emulsion 10%, IV

Fructose 10% in sodium chloride 0.9%

Fructose 10% in water

Invert sugar 5 and 10% in sodium chloride 0.9%

Invert sugar 5 and 10% in water

Ionosol products

Ringer's injection

Ringer's injection, lactated

Sodium chloride 0.45 or 0.9%

Sodium lactate (1/6) M

Drug Compatibility
Y-Site CompatibilityHID




Advice to Patients


Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Thiamine Hydrochloride


Dosage Forms


Brand Names




AHFS DI Essentials™. © Copyright 2024, Selected Revisions September 1, 2007. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.

† Off-label: Use is not currently included in the labeling approved by the US Food and Drug Administration.

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