Instavit D

Approved Indications:

• Prevention and treatment of water-soluble vitamin deficiencies in patients with inadequate oral intake, gastrointestinal disorders, or increased metabolic demands.
• Nutritional supplementation in critically ill patients receiving parenteral nutrition or undergoing major surgery, trauma, burns, or severe infections.
• Correction of vitamin deficiencies associated with chronic alcoholism, prolonged fasting, malabsorption syndromes, or cachexia.
• Postoperative recovery support, especially in patients unable to consume sufficient oral nutrition.

Clinically Accepted Off-label Uses:

• Supportive care in sepsis, major infections, or multi-organ dysfunction, particularly in ICU settings.
• Nutritional management in patients receiving chemotherapy or radiotherapy, where oral intake is compromised.
• Adjunct therapy in neurologic conditions like Wernicke's encephalopathy (requiring thiamine).

Route of Administration: Intravenous (IV) infusion

Adults:

• Typical daily dose: 1 vial (multivitamin, water-soluble) diluted in 500–1000 mL of 5% Dextrose and infused over 6–8 hours
• Frequency: Once daily or as advised based on nutritional status and clinical condition

Pediatric Patients:

• Neonates and Infants: 0.5–1 mL/kg/day of the multivitamin component diluted in 5% Dextrose (total volume based on fluid allowance)
• Children (1–12 years): 1–2 mL/kg/day (max 5 mL/day) in 5% Dextrose infused over 8–12 hours

Elderly:

• Same as adult dosing; monitor for renal or cardiac comorbidities that may require fluid restriction or slower infusion

Renal Impairment:

• Monitor electrolytes and fluid volume
• Reduce dose or frequency if accumulation of water-soluble vitamins (e.g., Vitamin C, B6) is suspected

Hepatic Impairment:

• Use with caution; adjust dose of vitamins with hepatic metabolism (e.g., niacin, folate)
• Monitor liver enzymes during long-term administration

Administration Instructions:

• Use IV infusion pump for controlled administration
• Do not mix with incompatible solutions or drugs
• Use immediately after dilution and discard any unused portion

Multivitamin [Water Soluble] + 5% Dextrose delivers essential water-soluble vitamins and glucose directly into the bloodstream, bypassing gastrointestinal absorption. The vitamin B-complex components act as coenzymes in oxidative metabolism, supporting energy production, neurotransmitter synthesis, red blood cell formation, and DNA replication. Vitamin C plays roles in collagen synthesis, antioxidant protection, and immune function. 5% Dextrose provides a readily available energy source, reduces protein catabolism, and facilitates cellular uptake and utilization of vitamins. This combination is critical in restoring nutritional balance during acute illness or when oral intake is not feasible.

Absorption:

• 100% bioavailability via intravenous route
• Immediate plasma availability

Distribution:

• Water-soluble vitamins rapidly distribute into plasma and tissues
• Minimal storage; excess excreted renally
• Dextrose is distributed throughout total body water

Metabolism:

• B vitamins and Vitamin C undergo hepatic or tissue metabolism depending on their role in enzymatic pathways
• Dextrose is metabolized via glycolysis and oxidative phosphorylation for ATP production

Elimination:

• Water-soluble vitamins: Renal excretion of unmetabolized excess
• Dextrose: Metabolized to CO₂ and water; minimal renal excretion unless hyperglycemia occurs

Half-life:

• Water-soluble vitamins: Short (ranging from hours to one day)
• Dextrose: Very short, used quickly by tissues

Pregnancy:

• No specific FDA pregnancy category assigned for this combination
• Individual components (e.g., thiamine, riboflavin, folic acid, Vitamin C) are generally considered safe during pregnancy at recommended doses
• Excessive doses should be avoided to prevent vitamin toxicity

Lactation:

• Most water-soluble vitamins are excreted in breast milk in small quantities
• Safe for use during breastfeeding at therapeutic doses
• Monitor infant for signs of vitamin overexposure in long-term use

Caution: Avoid high-dose parenteral use without clinical indication

• Primary Class: Parenteral Nutritional Supplement
• Subclass: Water-Soluble Multivitamin with Carbohydrate Carrier

• Known hypersensitivity to any component (e.g., thiamine, riboflavin, preservatives)
• Fluid overload or pulmonary edema (due to dextrose volume)
• Uncontrolled hyperglycemia or glucose intolerance
• Anuria or severe renal failure (risk of vitamin accumulation)
• Severe hepatic insufficiency (risk of altered metabolism)

• Use cautiously in patients with diabetes mellitus—monitor glucose closely
• Monitor renal and hepatic function during prolonged use
• Risk of Vitamin B6 neurotoxicity with prolonged high-dose administration
• Thiamine-related anaphylaxis (rare)—observe patient during initial administration
• Monitor for signs of fluid overload in cardiac or renal compromised patients
• Monitor serum electrolytes and vitamin levels in long-term use

Common:

• Transient flushing (especially with niacin)
• Nausea or mild abdominal discomfort
• Infusion site irritation or phlebitis

Less Common:

• Headache, dizziness
• Metallic taste or unpleasant odor in breath/urine (from B-complex vitamins)

Rare but Serious:

• Hypersensitivity reactions including rash, pruritus, or urticaria
• Anaphylaxis (especially with thiamine-containing products)
• Hyperglycemia or osmotic diuresis from excessive dextrose infusion
• Neuropathy with long-term high-dose pyridoxine

• Levodopa: Reduced efficacy due to pyridoxine (Vitamin B6) antagonism
• Warfarin: Vitamin C may reduce anticoagulant effect at high doses
• Alcohol: Increases requirement for B-complex vitamins
• CYP450 involvement: Minimal for water-soluble vitamins; not clinically significant
• Other parenteral solutions: Incompatibility may occur—do not co-administer without compatibility data

• ASPEN and ESPEN 2024 guidelines recommend routine multivitamin supplementation in critically ill or TPN-dependent patients
• Updated ICU protocols recommend earlier initiation of parenteral micronutrients (including water-soluble vitamins) in patients unable to eat within 5–7 days
• New preservative-free formulations are now available to reduce hypersensitivity risk
• WHO emphasizes inclusion of thiamine in early refeeding of malnourished patients or those with suspected deficiency

• Store below 25°C
• Protect from light, particularly for Vitamin B2 and Vitamin C
• Do not freeze
• Use immediately after opening or dilution
• Discard any unused solution within 24 hours of preparation
• Shake well before use if in suspension form