Pabrinex Shortage

Pabrinex® Intravenous (IV) injection will be out of stock from August 2024 until at least September 2025.
Pabrinex® Intramuscular (IM) injection is being discontinued, with stock exhaustion expected from December 2024.
There are no other licensed parenteral alternatives to Pabrinex® IV and IM injections.
Thiamine 50mg and 100mg tablets remain available and should be used where clinically appropriate.
Medicine Supply Notification (MSN/2024/038) for Pabrinex® (Vitamins B and C) Intravenous and Intramuscular High Potency solution for injection ampoules (03/04/2024)
 
A clinical working group has been convened, to which the BPNG are contributing, to produce clinical guidance to support trusts and clinicians on the priorities for the use of Pabrinex during the period of limited supply.
 
Until this formal guidance is issued, organisations are being advised to rationalise all prescribing to, and to reserve stock for, only those individuals requiring Pabrinex® for the treatment of life threatening conditions, namely Wernicke’s encephalopathy/Korsakoff psychosis. In this situation the IV preparation must be used to ensure diffusion across the blood brain barrier.
 
Patients at risk of refeeding syndrome are at a higher risk of Wernicke’s encephalopathy/Korsakoff psychosis due to thiamine depletion. Local protocols for refeeding syndrome should be reviewed.
The intravenous route should only be used for refeeding where the oral or enteral route is not available or for those at very high risk of refeeding syndrome. Pabrinex should be used at the lowest clinically suitable dose and course length.
 
Overprescribing with high doses, frequencies and durations should be avoided to preserve stock.
 
Thiamine and Vitamin B Co Strong tablets remain available and should be used as appropriate when clinically indicated as first line choice of vitamin B supplementation.
 
Guidance will be issued by a clinical stakeholders group in the coming weeks. The BPNG will update any guidance when available.