Response

Meldon Kahan

I thank Ms Shakory for a concise and evidence-based review of the role of thiamine in the management of alcohol use disorders in response to the “Office management of alcohol withdrawal” document.¹ While thiamine is routinely administered in acute care settings, Ms Shakory correctly points out that thiamine supplementation also has a role in primary care settings. Oral supplementation of 100 mg per day is recommended for at least 1 month after parenteral supplementation in an emergency or inpatient setting.² While evidence-based guidelines are lacking, long-term oral supplementation (50 to 100 mg) should be considered for 2 high-risk groups: those who are chronically malnourished and those with chronic liver failure.

Footnotes

Competing interests
None declared
The opinions expressed in letters are those of the authors. Publication does not imply endorsement by the College of Family Physicians of Canada.

References

1.↵
Medical issues in the office management of alcohol use disorders: addiction care is primary care. Office management of alcohol withdrawal. Scarborough, ON: Families for Addiction Recovery; 2019. Available from: https://www.cfpc.ca/uploadedFiles/Resources/Resource_Items/Health_Professionals/AUD-Nov19-EN.pdf. Accessed 2020 Feb 3.
2.↵
1. Clarke S,
2. Franklyn M,
3. Kahan M,
4. Leary T,
5. Nikodem P
. Mentoring, Education, and Clinical Tools for Addiction: Primary Care–Hospital Integration (META:PHI). Clinical best practices in addiction medicine. A guide for RAAM clinicians. Toronto, ON: Women’s College Hospital; 2019. Available from: http://www.metaphi.ca/assets/documents/provider%20tools/RAAM_BestPractices.pdf. Accessed 2020 Feb 11.