General practitioners are often the initial point of contact for patients with alcohol-related concerns, positioning them at the forefront of early identification and intervention. By screening for risky or escalating alcohol use and initiating timely thiamine (Vitamin B1) supplementation, GPs can play a vital role in harm minimisation and in preventing serious complications associated with alcohol-related nutritional deficiencies.
Patients who engage in risky drinking—defined as consuming more than ten standard drinks per week or more than four standard drinks in a single day—or who have alcohol dependence are especially prone to thiamine deficiency. This is largely due to poor nutritional intake, gastric lining damage, and impaired thiamine absorption.
Timely thiamine supplementation is essential and has been shown to effectively prevent and treat Wernicke’s encephalopathy, as well as associated memory impairment, when administered early and routinely. In addition to supplementation, emphasising adequate nutrition is a critical component for addressing nutritional deficiencies.
According to Australian guidelines, healthy individuals who consume alcohol at risky levels but maintain adequate nutrition should receive 300mg of oral thiamine (100mg three times a day) for three to five days, followed by 100mg daily for an additional 4–9 days (totalling 1 to 2 weeks of oral thiamine).
For patients with risky alcohol consumption and poor dietary intake or a general poor nutritional state, the Guidelines for the Treatment of Alcohol Problems recommend administering parenteral thiamine, followed by oral thiamine doses of 300mg per day for several weeks (Preventing and Treating Wernicke’s Encephalopathy). Additionally, 100mg of oral thiamine should be considered and continued indefinitely for those with ongoing alcohol dependence.
Thiamine is readily accessible and can be purchased over the counter at most pharmacies, making it an easy and practical intervention.
For further guidance, practitioners may refer to key resources, including the Guidelines for the Treatment of Alcohol Problems, NSW Health’s Management of Withdrawal from Alcohol and Other Drugs, and the RACGP’s Malnutrition, Nutritional Deficiency and Alcohol: A Guide for General Practice.
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