Nervin

Approved and Clinically Accepted Uses

• Prevention and Treatment of Deficiencies
• Thiamine: beriberi (dry, wet), Wernicke’s encephalopathy (acute) and Korsakoff psychosis (chronic)
• Riboflavin: ariboflavinosis (cheilosis, glossitis, seborrheic dermatitis)
• Pyridoxine: deficiency—rare and seen in malnutrition, chronic alcoholism, isoniazid therapy
• Neuropathy and Neurologic Disorders
• Pyridoxine: diabetic and alcoholic neuropathy; pyridoxine-responsive seizures in infants
• Combined use supports nerve function in neurodegenerative diseases
• Metabolic Support
• Prevention of hyperhomocysteinemia via conversion of homocysteine to cystathionine (B6-dependent enzyme)
• Support in energy metabolism and mitochondrial disorders
• Cardiovascular and Migraines
• Riboflavin: migraine prophylaxis in high-dose regimens; B6/B2 combination supports endothelial function
• Pregnancy and Growth
• B-complex support during pregnancy, lactation, and in growth phases

Route: Oral (tablets, capsules, liquids); IM/IV for acute deficiency (e.g., Wernicke’s).

Adults:

• B1 (Thiamine):
• Oral: 1.1–1.2 mg/day (RDA); therapeutic: 50–100 mg daily; acute: 200–500 mg IV/IM daily for 1–3 days
• B2 (Riboflavin):
• Oral: 1.1–1.3 mg/day; migraine prophylaxis: 400 mg/day
• B6 (Pyridoxine):
• Oral: 1.3–1.7 mg/day RDA; neuropathy: 50–100 mg/day

Pediatrics:

• Dosing by age/weight following RDA guidelines:
• B1: 0.5–0.9 mg
• B2: 0.5–0.6 mg
• B6: 0.3–0.6 mg; seizures: therapeutic up to 2–30 mg/kg/day (with medical monitoring)

Elderly:

Same as adult; adjust if malabsorption or polypharmacy present.

Renal/Hepatic Impairment:

No standard dose reductions; use with clinical monitoring.

Administration Notes:

Take with meals. In severe deficiency, IV/IM route is preferred.

Thiamine (B1) is converted into thiamine pyrophosphate (TPP), a cofactor for pyruvate and α-ketoglutarate dehydrogenases, supporting carbohydrate energy metabolism and neuronal function. Riboflavin (B2) forms FAD/FMN, essential for redox reactions in mitochondria, antioxidant regeneration, and biotin/vitamin B6 activation. Pyridoxine (B6) converts to pyridoxal-5'-phosphate (PLP), a coenzyme in amino acid metabolism, neurotransmitter synthesis (GABA, serotonin), hemoglobin formation, and homocysteine conversion. Together, these vitamins support energy production, neurologic integrity, and metabolic homeostasis.

• Absorption:
  Active and passive transport in the small intestine; absorption decreases at high doses.
• Distribution:
  Water-soluble; limited tissue storage except small B1 reserves; 80–90% bound to plasma proteins for B2/B6.
• Metabolism:
  B1/B2 converted to active coenzymes (TPP, FAD). B6 metabolized in liver to PLP.
• Excretion:
  Water-soluble; clearance via renal excretion (urine), half-lives range from ~1 hour (B2, B6) to ~30 minutes (thiamine).

• Pregnancy:
  No FDA category but recognized as safe and essential at RDA levels. High-dose B6 therapy (<200 mg/day) assessed for pregnancy-induced nausea with no teratogenicity.
• Lactation:
  B-vitamins pass into breast milk; supplementation supports neonatal needs.
• Caution:
  High-dose pyridoxine (>200 mg/day) requires medical supervision.

• Primary Class: Water-soluble vitamins
• Subclass: B-complex vitamins
• Pharmacologic Category: Essential nutrient coenzymes

• Known allergy to thiamine, riboflavin, or pyridoxine
• Uncontrolled epilepsy (pyridoxine may worsen seizure frequency in rare cases)
• High-dose pyridoxine contraindicated with existing sensory neuropathy

• Allergic Reactions: Rare anaphylaxis possible with IV/IM thiamine
• Pyridoxine Toxicity: ≥200 mg/day long-term may cause sensory neuropathy
• Seizure Management: Monitor epileptics on pyridoxine
• Migraine Therapy: Riboflavin may trigger gastrointestinal symptoms
• Monitor renal/hepatic status during therapeutic-dose use

• Common:
• GI discomfort (B6)
• Mild headache or flushing (riboflavin)
• Rare/Serious:
• IV thiamine: rare anaphylaxis
• B6-induced neuropathy at high-dose chronic therapy (numbness, ataxia)
• Photosensitivity (riboflavin)
• Dose Dependency:
  Adverse reactions generally at pharmacologic/high doses, not within RDA range

• Levodopa: High-dose B6 increases peripheral metabolism—may reduce efficacy
• Isoniazid: Induces B6 deficiency—co-supplementation essential
• Oral contraceptives/Phenytoin/Phenobarbital: Decrease B-complex levels
• Zinc supplement: May reduce riboflavin absorption at high doses
• Alcohol: Inhibits absorption and metabolism of all three vitamins

• EFNS (2022): High-dose riboflavin (400 mg/day) recommended for migraine prophylaxis
• WHO/CDC: Thiamine with refeeding in malnourished populations to prevent Wernicke’s risk
• Clinical alerts: High-dose B6 (>200 mg/day) linked to neuropathy—monitor serum levels
• No new formal contraindications by FDA or EMA at nutritional dosing

• Temperature: 15–25 °C (59–77 °F)
• Light: Protect from direct sunlight (riboflavin is light-sensitive)
• Humidity: Store in a dry environment, container tightly closed
• Form-specific:
• Liquids: shake before use
• Tablets/capsules: keep in original packaging
• Keep out of reach of children
• Refrigeration generally not required unless specified