Anaphylactic reactions have been reported following large intravenous doses of thiamine. There have been very rare reports of anaphylactic reactions following IV injection of Cernevit†-12 (multivitamins for infusion) over 1-4 minutes. Urticaria and rash have also been associated with Cernevit†-12 (multivitamins for infusion).

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The dosage of drugs known to be influenced by folic acid and pyridoxine, for example phenytoin and phenobarbital, must be carefully monitored. Pyridoxine can reduce the effect of levodopa. Several drugs are known to influence the serum concentration of vitamins. An in vitro study ² using therapeutic concentrations of glycocholic acid (0.177 mg glycocholate/mL human serum) demonstrated a 50-80% increase in the unbound (free) fraction of drugs known to bind a ₁-acid glycoprotein (e.g., disopyramide, propranolol, quinidine, and prazosin). Although the in vivo response has not been determined, physicians should closely monitor patients for the possibility of an increase in the therapeutic response to drugs binding to a₁ -acid glycoprotein. Consult appropriate references for drugs that bind to a₁ -acid glycoprotein^3,4 and for listings of specific drug-vitamin interactions.

Folic acid has been reported to be unstable in the presence of calcium gluconate. Bisulfites have been reported to affect the stability of Vitamin A, thiamine, and ascorbic acid.⁵ The pH of the parenteral nutrition admixture may affect the stability of Vitamin C and thiamine.⁵ Bleomycin can be inactivated by ascorbic acid and riboflavin. Several vitamins have been reported to decrease the activity of certain antibiotics. Admixture or Y-site administration of alkaline drugs through a vitamin infusion should be avoided. Cernevit†-12 (multivitamins for infusion) should not be admixed directly into a lipid emulsion. Cernevit†-12 (multivitamins for infusion) may be combined with parenteral nutrition containing a lipid emulsion. The prime destabilizers of emulsions are excessive acidity (low pH) and inappropriate electrolyte content. Careful consideration should be given to additions of divalent cations (Ca++ and Mg++) which have been shown to cause emulsion instability. Consult the current literature for physical compatibility of drugs with parenteral nutrition.

Last reviewed on RxList: 12/8/2004
This monograph has been modified to include the generic and brand name in many instances.