Which medications are used in the treatment of Wernicke-Korsakoff syndrome (WKS)?

Updated: May 16, 2018
  • Author: Glen L Xiong, MD; Chief Editor: David Bienenfeld, MD  more...
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Traditional regimens in the United States have used 100 mg of parental (intravenous or intramuscular) thiamine for 3-7 days (treatment period), followed by oral thiamine indefinitely as long as the patient is consuming alcohol. Because of case reports suggesting that much higher doses are needed (up to 1 g of parental thiamine) to obtain resolution of symptoms, some authorities such as the Royal College of Physicians have suggested 500 mg intravenously 3 times a day for 2-3 days. [45] If no response is noted, discontinue supplementation and assess for supportive care (unless the patient is comatose). If there is a partial response, continue at 250 mg parenterally for 5 days or as long as improvement continues in patients with neuropsychiatric symptoms. [34, 27]

Use of high-dose thiamine (500 mg TID intravenously) may be indicated given the detrimental consequence of untreated or undertreated WKS. A response to high-dose thiamine was reported as last as 30 days after initial recognition and treatment with thiamine at 100mg/day IV. [46] Monitoring of thiamine levels after treatment may be useful in guiding both route of administration and dosing.

After the patient’s response has plateaued, supplement with oral thiamine indefinitely until the patient is no longer at risk (eg, as long as they are drinking alcohol).

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