Pabrinex/Vitamin B&C Intravenous High Potency, Concentrate for Solution for Infusion

Vitamin B&C Intravenous High Potency, Concentrate for Solution for Infusion ('Vitamin B&C IVHP') is indicated in adults and children for rapid therapy of severe depletion or malabsorption of the water soluble vitamins B and C:

• particularly in alcoholism, where a severe depletion of thiamine can lead to Wernicke's encephalopathy

• after acute infections

• post-operatively

• in psychiatric states

Also used to maintain levels of vitamin B and C in patients on chronic intermittent haemodialysis.

Adults and elderly:

Rapid therapy of severe depletion or malabsorption of the water soluble vitamins B and C, particularly in alcoholism, where a severe depletion of thiamine can lead to Wernicke's encephalopathy

2 to 3 pairs of 5 ml ampoules (1 pair = ampoule 1 + ampoule 2) diluted with 50 ml to 100 ml infusion solution (physiological saline or glucose 5%) and administered over 30 minutes every 8 hours, or at the discretion of the physician.

Psychosis following narcosis or E.C.T; toxicity from acute infections

1 pair of 5 ml ampoules diluted with 50 ml to 100 ml infusion solution (physiological saline or glucose 5%) administered over 30 minutes twice daily for up to 7 days.

Haemodialysis

1 pair of 5 ml ampoules diluted with 50 ml to 100 ml infusion solution (physiological saline or glucose 5%) administered over 30 minutes once every two weeks at the end of dialysis.

Paediatric population

Vitamin B&C Intravenous High Potency, Concentrate for Solution for Infusion is rarely indicated for administration to children; however, suitable doses are as follows:

Method of administration

Dilute before use.

Vitamin B&C Intravenous High Potency, Concentrate for Solution for Infusion should be administered by drip infusion. Equal volumes of the contents of ampoules number 1 and 2 should be added to 50 ml to 100 ml physiological saline or 5% glucose and infused over 30 minutes (see sections 6.3 and 6.6).

Hypersensitivity to the active substances or to any of the excipients listed in section 6.1.

Although potentially serious allergic adverse reactions such as anaphylactic shock may occur rarely during, or shortly after, parenteral administration of Vitamin B&C IVHP, such rare occurrence of serious allergic reactions should not preclude the use of Vitamin B&C IVHP in patients who need treatment by this route of administration particularly those at risk of Wernicke's encephalopathy - for whom treatment with parenteral thiamine is essential.

Initial warning signs of a reaction to Vitamin B&C IVHP are sneezing or mild asthma and those treating patients need to note that the administration of further injections to such patients may give rise to anaphylactic shock. Facilities for treating anaphylactic reactions should be available whenever Vitamin B&C IVHP is administered. To minimise the risk of such events with Vitamin B&C IVHP, this medicinal product should be administered by infusion over a period of 30 minutes.

This medicine is for injection into a vein only and should not be given by any other route

Care should be taken to ensure that the route of administration used (intramuscular or intravenous) is that intended – reports of unintentional administration by the wrong route have been received; these incidents have not been associated with serious adverse reactions.

In common with all parenteral products each ampoule should be visually inspected prior to administration and should not be used if particulates are present.

The content of pyridoxine may interfere with the effects of concurrent levodopa therapy.

No adverse effects have been reported at recommended doses when used as clinically indicated.

Animal studies are insufficient with respect to reproductive toxicity (see section 5.3). The potential risk for humans is unknown.

Caution should be exercised when prescribing to pregnant women.

No studies on the effects on the ability to drive and use machines have been performed. However given the nature of the product, no effects are anticipated.

Adverse reactions reported as possibly associated to Vitamin B&C IVHP are presented in the following table by MedDRA System Organ Class (SOC), Preferred Term and frequency. The following frequency categories are used:

Very common (>1/10);

Common (>1/100, <1/10);

Uncommon (>1/1,000, <1/100);

Rare (>1/10,000, <1/1,000);

Very rare (<1/10,000), including isolated reports.

Post-marketing adverse reactions are reported voluntarily from a population with an unknown rate of exposure. Therefore it is not possible to estimate the true incidence of adverse reactions and the frequency is “unknown”.

Tabulated summary of adverse reactions

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard, or search for MHRA Yellow Card in the Google Play or Apple App Store.

In the unlikely event of overdosage, treatment is symptomatic and supportive.

Vitamin B&C IVHP contains vitamins B1, B2, B6, nicotinamide, vitamin C and glucose.

ATC code: A11EB

Not supplied.

There are no pre-clinical data of relevance to the prescriber which are additional to that already included in other sections of the Summary of Product Characteristics.

Edetic acid

Sodium hydroxide

Water for Injections

This medicinal product must not be mixed with other medicinal products except those mentioned in section 6.6.

Before opening:

24 months.

After opening:

Chemical and physical in-use stability of intravenous high potency vitamins B and C has been demonstrated at 2-8°C, and at 25°C, protected from light, for 24 hours in the following infusion fluids:

- Glucose 5%

- Physiological saline (sodium chloride 0.9%)

From a microbiological point of view, the product should be used immediately. If not used immediately, in-use storage times and conditions prior to use are the responsibility of the user and would normally not be longer than 24 hours at 2 to 8°C, unless dilution has taken place in controlled and validated aseptic conditions.

Do not freeze diluted solutions.

Do not store above 25°C. Keep the container in the outer carton. Do not freeze.

For storage conditions after dilution of the medicinal product, see section 6.3.

Vitamin B&C Intravenous High Potency, Concentrate for Solution for Infusion is supplied in pairs of amber glass ampoules of 5 ml. Packs contain either, six or ten pairs of 5 ml ampoules.

Not all pack sizes may be marketed.

Compatibility of Vitamin B&C IVHP has been demonstrated with the following infusion fluids:

• Glucose 5%

• Physiological saline (sodium chloride 0.9%)

• Glucose 4.3% with sodium chloride 0.18%

• Glucose 5% with potassium chloride 0.3%

• Sodium lactate M/6

Please refer to section 6.3 for details regarding storage following dilution in each of these fluids.

Any unused medicinal product or waste material should be disposed of in accordance with local requirements.