Dr. Costantini sent the following article this morning for the HU forum members to read regarding HDT overdosing since it is currently a very popular subject.
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Effects of Overdose of High-Dose Thiamine
Treatment
Introduction
We treat Parkinson’s disease with high dose thiamine in
addition to the classic therapy since 2012. On this topic, we
published three studies carried out with Italian patients [1-3]. The
treatment consisted in performing 2-3 intramuscular injections of
100mg of thiamine per week. The highest dosage was reserved to
patients whose disease severity was the greater, long past onset, and
patients whose weight was more than 90kg. We also treated patients
on anticoagulants. In this case, the thiamine was administrated
orally (tablets). We noticed that in order to obtain comparable
results of the intramuscular therapy with the oral therapy we
needed to administrate a dose of thiamine 140 times when treated
with tablets or capsules (personal data, not published). In other
words, in order to obtain the same clinical effect of 1 intramuscular
injection of 100mg of thiamine once a week, it was necessary to
administrate 14 grams of thiamine orally per week, or 2 grams per
day. This dosage, when appropriate for the patient, has always been
well tolerated and we did not observe collateral effects.
At the end of 2015, our patient’s pool was considerable, and we
began to notice that some patient, after the first two weeks on high
dose thiamine protocol, would show an initial general improvement
followed by a worsening of the original symptoms. We started to
think that the cause could be attributed to an excessive dose of
thiamine for that specific patient, since we have observed a similar
behavior in other diseases [4-6]. Suspending the thiamine protocol
for a week led to the regression of the worsening of symptoms. The
therapy would then be restarted at halved dosage, which could
be further adjusted to reach the correct dosage for the patient
and obtain a consistent decrease of the symptoms without any
collateral effect. We deem that the appearance of the symptoms
of thiamine overdose could have an incidence of about 1% of the
patients treated with 200-300mg of thiamine per week or with
the corresponding oral doses. We also observed a prevalence of
thiamine overdose manifestation in newly diagnosed patients, or
in patients whose symptoms are mild or who have a small body
mass. Over the past months, we began to treat a number of patients
of Anglo-Saxon and African origin. Initially we started the therapy
with the same schedule used for patients visited in Italy and
described in our studies. The vast majority of the patients showed
quite soon symptoms attributable to overdose of thiamine, even
the same day of the first thiamine administration. Some patients
showed, in addition to a general feeling of discomfort, unrest and
an overall worsening of the symptoms of Parkinson’s disease, also
a medium intensity migraine. Such a symptomatology regressed
after a few days after the high dose of thiamine was suspended and
consequently restarted with halved doses. In other words, these
patients have been observed to require, on average, lower doses
than those of Italian patients in order to return the same favorable
effects on the symptoms. Other ethnicities could be more or less
sensitive to the therapy with high dose thiamine. In light of the
above, we recommend that colleagues and practitioners begin the
treatment with patients of ethnicity other than Italian with doses
that are half of what we published previously with reference to
the case studies we observed directly. The correct dose, in our
experience, is the one that improves the symptoms of Parkinson’s
disease and improves the sense of balance bringing the score of the
pull-test close to normal, as opposed to its altered state due to the
disease.
Conflicts of Interests
On behalf of all authors, the corresponding author states that
there is no conflict of interest..
References
1. Costantini A, Fancellu R (2016) An open-label pilot study with high-dose
thiamine in Parkinson’s disease. Neural Regen Res 11(3): 406-407.
2. Costantini A, Pala MI, Grossi E, Mondonico S, Cardelli LE, et al. (2015)
Long-term treatment with high-dose thiamine in Parkinson disease: An
Open-Label Pilot Study. J Altern Complement Med 21(12): 740-747.
3. Costantini A, Pala MI, Compagnoni L, Colangeli M (2013) High-dose
thiamine as initial treatment for Parkinson’s disease. BMJ Case Rep. pii:
bcr2013009289.
4. Costantini A, Pala MI (2013) Thiamine and fatigue in inflammatory
bowel diseases: An open-label pilot study. J Altern Complement Med
19(8): 704-708.
5. Costantini A, Tiberi M, Zarletti G, Pala MI, Trevi E (2018) Oral high-dose
thiamine improves the symptoms of chronic cluster headache. Case
Reports in Neurological Medicine. Article ID 3901619.
Copyright © All rights are reserved by Antonio Costantini. 1/2
Volume - 4 Issue - 1
Antonio Costantini1* and Roberto Fancellu2
1
Department of Neurological Rehabilitation, School of Physiotherapy, Italy
2
Neurology Unit, Italy
*Corresponding author: Antonio Costantini, Department of Neurological Rehabilitation, Italy
Submission: December 03, 2018; Published: December 06, 2018
6. Costantini A, Laureti T, Pala MI, Colangeli M, Cavalieri S, et al. (2016)
Long-term treatment with thiamine as possible medical therapy for
Friedreich ataxia. J Neurol 263(11): 2170-2178.
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