What are the medication recommendations for 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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Wernicke-Korsakoff syndrome results from thiamine deficiency. The treatment is replacement of this essential vitamin. Previously, the usual dose was 100 mg/day via oral, intravenous, or intramuscular administration. However, the US and International standard of care appears to be shifting towards high-dose thiamine (500 mg tid) for a brief period (2-3 days), then reassessing the patient for improvement. In cases in which the patient is alert and is demonstrating improvement, parental (intravenous/intramuscular) thiamine should continue as long as the patient continues to improve, usually at 250 mg daily.

In patients who are comatose, intravenous thiamine should be continued, but no clear recommendations have been determined.

In patients whose responses plateau, which happens with most patients with Wernicke-Korsakoff syndrome, oral thiamine should be administered at 50-100 mg/day to prevent further neurodestruction if the patient continues to drink or will be vulnerable to thiamine deficiency for any other reason.

It is worth noting that the above recommendations are based on the British Royal College of Physicians guidelines, themselves based on case studies that reported patients who required high doses to demonstrate improvement. Since these recommendations were adopted in the United Kingdom, several other international reports have described patients who required high-dose parental thiamine before Wernicke Encephalopathy symptoms resolved. This regimen is also increasingly recommended by gastroenterologists in the United States and is being adopted by academic medical centers in the United States, Europe, Australia, and New Zealand. The use of this regimen in Wernicke-Korsakoff syndrome is purely an extrapolation of these recommendations and case reports.

European guidelines are similar but suggest a dose of 200 mg of preferably intravenous thiamine 3 times a day until symptoms resolve.

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