Vitamin B vs thiamine

Below are the database queries which are used to create this measure. These are run against a copy of the BSA prescribing data which we store in Google BigQuery. We're working on making our BigQuery tables publicly available at which point it will be possible to run and modify these queries yourself. But even where code and database queries are not directly useable by others we believe it is always preferable to make them public.

Description Prescribing of vitamin B complex (normal and strong tablets) as a percentage of prescribing of vitamin B and thiamine tablets
Why it matters One of the most common reasons why vitamin B has been prescribed is to prevent Wernicke's encephalopathy in chronic alcohol disorders. However, a 2019 position statment from the Regional Medicines Optimisation Committee (RMOC) provided the following guidance:

  • Do not initiate vitamin B compound or vitamin B compound strong tablets for any of the following indications:
    • Prevention of WE in alcoholism
    • Dietary supplementation
    • Prevention of deficiency
    • Maintenance treatment following treatment of deficiency
  • Review all existing patients prescribed vitamin B complex preparations with a view to stopping treatment in all but exceptional circumstances, such as in those patients with a medically diagnosed deficiency due to lifelong or chronic condition, or following surgery that results in malabsorption. If all relevant patient factors have been taken into account and it is considered appropriate to stop, treatment may be stopped immediately.
  • The decision to discontinue treatment should be carefully explained to the patient, and should emphasise the positive aspects of discontinued prescribing of drugs with a low clinical value.
  • Advise patients who wish to use these vitamin B preparations as dietary supplements to purchase them over the counter
  • Prescribe prophylactic oral thiamine 200 to 300 mg daily in divided doses to harmful or dependent drinkers for prevention of WE continued for as long as malnutrition is present and/or during periods of continued alcohol consumption.
  • Review patients prescribed thiamine with a view to stopping if the patient has been abstinent for 6 weeks or more and has regained adequate nutritional status.
  • Patients who require continued treatment with thiamine should be reviewed at appropriate intervals depending on individual circumstances.

Please see our other measure: Vitamin B per 1000 patients.
Tags Efficacy, NICE, Cost Saving
Implies cost savings No
Authored by richard.croker
Checked by andrew.brown
Last reviewed 2024-02-12
Next review due 2026-02-12
History View change history on GitHub →

Numerator SQL

SELECT
     CAST(month AS DATE) AS month,
     practice AS practice_id,
     SUM(items) AS numerator
 FROM hscic.normalised_prescribing
 WHERE bnf_code IN ("0906027G0AAAAAA", "0906027G0AAABAB", "0906027G0BLABAB", "0906027G0BMAAAA", "0906027G0BMABAB")
 GROUP BY month, practice_id

Denominator SQL

SELECT
     CAST(month AS DATE) AS month,
     practice AS practice_id,
     SUM(items) AS denominator
 FROM hscic.normalised_prescribing
 WHERE bnf_code IN ("0906026M0AAAFAF", "0906026M0AAAGAG", "0906026M0BBAKAG", "0906026M0BGAAAF", "0906026M0BGABAG", "0906026M0BIAAAG", "0906026M0BIABAF", "0906026M0BJAAAG", "0906026M0BJABAF", "0906026M0BKAAAG", "0906026M0BKABAF", "0906027G0AAAAAA", "0906027G0AAABAB", "0906027G0BLABAB", "0906027G0BMAAAA", "0906027G0BMABAB")
 GROUP BY month, practice_id
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