By Traci Pantuso, ND, MS
Adjunct Faculty, Bastyr University, Seattle; Owner, Naturopathic Doctor Harbor Integrative Medicine, Bellingham, WA
Dr. Pantuso reports no financial relationships relevant to this field of study.
SUMMARY POINTS
- The actual use of IV nutrient therapies (IVNT) currently is unknown.
- There are numerous IVNT formulations containing various nutrients that have not been adequately researched for safety and/or efficacy.
- IVNT has surprisingly high costs both financially and because of potential health risks.
Intravenous nutrient therapies (IVNT) are gaining in popularity, with IVNT clinics popping up in many cities throughout the United States.1 The IV nutrient clinics are marketing IVNT to maintain overall wellness, enhance weight loss, boost immune function, increase athletic performance, cure hangovers, and treat particular conditions.1,2 IVNTs have been popular treatments in integrative healthcare clinics for decades as treatments for numerous health conditions.2,3 It is difficult to estimate the number of IVNT clinics and providers in the United States; however, a study investigating the use of IV vitamin C (component of many IVNT formulas) in 2006 and 2008 found that the manufacturers’ yearly sales were 750,000 and 855,000 vials, respectively.3 And, these were thought to be underestimates. Unfortunately, the increase in the use of IVNT in both healthy individuals and those with health conditions has not translated into increased published research studies investigating the efficacy and safety of IVNT.
The indications for IVNT use are numerous and somewhat vague.1-4 Historically, IVNT has been purported to be used to treat upper respiratory infections and fatigue.2,4 Currently, IVNT is purported to treat or adjunctively treat fibromyalgia syndrome (FMS), fatigue, cancer, depression, asthma, migraines, cardiovascular disease, allergies, narcotic withdrawal, and hyperthyroidism.1-5 With the exception of magnesium sulfate and calcium as monotherapy, few studies support the use of IVNT.2,6,7
One of the most well-known IVNTs is vitamin C, which was made famous by Linus Pauling. Ewan Cameron reported high-dose IV vitamin C improved survival times in cancer patients in 1976.8 IVNTs contain a wide assortment of vitamins and minerals other than vitamin C.1,2,9 Currently, the most popular IVNT probably is the “Myers’ cocktail,” which contains 2-5 mL magnesium chloride hexahydrate (20%), 1-3 mL calcium gluconate (10%), 1 mL vitamin B12 (hydroxocobalamin; 1,000 mcg/mL), 1 mL vitamin B6 (pyridoxine hydrochloride (100 mg/mL), vitamin B5 (dexpanthenol 250 mg/mL), 1 mL of vitamin B complex 100 (B complex), and 4-20 mL of vitamin C (222 mg/mL).2
According to one of the most well-cited articles on IVNT, the use of the Myers’ cocktail can be traced back to John Myers, who pioneered the use of IV vitamins and minerals for the treatment of various conditions.2 After Myers died in 1984, a number of his patients began seeking infusions from Alan Gaby.2 Gaby reports that he did not know the exact formula that Myers used and had to design the modified Myers’ formula as described previously.2 IVNT providers use various formulations in different clinics as demonstrated on the IVNT clinic websites, such as RestoreIV.com and TheRemedyroom.com.
Clinical Research
Much of the knowledge that supports the use of IVNT other than the use of IV magnesium and calcium is anecdotal and from individual case studies.1-5 IV magnesium sulfate has been studied as a treatment for asthma and has demonstrated benefit in adults and children.6 IV magnesium also has been investigated as a treatment for headaches and migraines and has demonstrated mixed results.7
Currently, the efficacy of high-dose IV vitamin C as a cancer treatment is unclear and being investigated.10-12 A 2015 systematic review concluded that there is no high-quality evidence to suggest that vitamin C, whether oral or IV, enhances antitumor effects of chemotherapy or reduces its toxicity.11 ClinicalTrials.gov has numerous registered research studies investigating the use of IV vitamin C as a cancer treatment that have been completed but have yet to publish findings.12 Currently, the National Institutes of Health considers IV vitamin C to be experimental and recommends that it be used only in the context of a clinical trial.10
In a 2009 randomized, placebo-controlled trial investigating the effects of IVNT in FMS patients, the authors found no difference between the placebo and the IVNT groups.5 The placebo group received lactated Ringer’s solution intravenously, while the IVNT group received a Myers’ cocktail once a week for eight weeks, with both groups demonstrating improvement in FMS symptoms.5 The authors found a strong placebo effect within this study, which is consistent with other studies demonstrating a greater placebo effect for IV infusions in health clinics over oral administration.1,5
Contraindications/Side Effects
According to Padayatty et al, it is difficult to determine the actual numbers of adverse events with IV vitamin C, as use and adverse events are underreported.3
Known contraindications to IV vitamin C are pre-existing renal insufficiency or failure and glucose-6-phosphate dehydrogenase (G-6-PD) deficiency, as these individuals are predisposed to vitamin C toxicity. There have been cases of individuals with G-6-PD deficiency who have experienced acute hemolysis due to high-dose IV vitamin C.13 Acute oxalate nephropathy and renal failure also have been reported after high-dose IV vitamin C.14-16
In the FMS study, one out of 34 participants who received the Myers’ cocktail IV reported an adverse event, with increased feelings of depression, insomnia, and dyspepsia, and had increases in blood pressure.5 A 2016 non-randomized, controlled study compared the effect of IV vitamin C to another IVNT formulation containing different combinations of zinc, glutathione, alpha-linoleic acid, and B vitamins on blood pressure levels during and at the end of IV treatment. The researchers found that high-dose IV vitamin C (30 g) reduced both systolic and diastolic blood pressure by 6-7 mmHg, while IVNT containing B12 increased both systolic and diastolic blood pressure by 13 mmHg and 11.5 mmHg, respectively.9
There is also a case report of a patient who was using high-dose oral vitamin C and amygdalin (B-17), which resulted in cyanide poisoning; one of the breakdown products of amygdalin is cyanide.17
Gaby recommends that elderly patients may have a lower tolerance to the Myers’ infusion and may require lower doses of the nutrients.2 Patients with cardiac disease and those taking medications that deplete potassium should be screened for hypokalemia before receiving a Myer’s infusion because of the risk of cardiac arrhythmias. There have been reports of anaphylaxis to thiamine that often occur after multiple separate administrations of thiamine. According to Gaby, from 1965-1985, nine deaths worldwide were attributed to IV, intramuscular, or subcutaneous administration of thiamine.2 The more common side effects to the Myers’ infusion are a burning sensation at the injection site and phlebitis caused by the hypertonicity of the infusion. These side effects can be decreased by diluting the nutrients and repositioning the needle at the injection site. Hypotension also can occur and appears to be due to administering the infusion too quickly, which can lead to lightheadedness and syncope. Infection is also a risk, particularly in individuals with underlying illnesses who may be at higher risk.
Logistics
Most insurance companies do not cover the cost of IVNT, so the cost can be prohibitive. IVNT infusions at RemedyRoom.com in New Orleans cost anywhere from $149 to $249 and RestoreIV.com in Philadelphia start at $99 and go up to $149. The administration of the IV nutrients is the biggest cost, as it can take hours to infuse some IVNT infusions. The IVNT clinics also advertise “add ons,” including other nutrients (glutathione, coenzyme Q10, selenium, alpha-lipoic acid, zinc, fatty acids) and even UV light treatment of blood.
Conclusion
IVNT is used widely, and physicians should be aware that both healthy individuals and those with health conditions may seek IVNT treatments. Physicians should be aware of potential interactions of IVNT with both conventional treatments and integrative treatments. The safety profile of IVNT is not well-established and efficacy remains questionable, as the placebo effect may be the reason individuals feel better after IVNT. The cost is quite high for these treatments without insurance coverage, and risks to IVNT range from mild to severe. IVNT is seriously lacking in research on safety and efficacy, so physicians should educate patients about potential risks.
REFERENCES
- English T. Skeptics Question The Value of Hydration Therapy for the Healthy. Available at: http://www.npr.org/sections/health-shots/2016/10/17/497656703/skeptics-question-the-value-of-intravenous-fluids-for-the-healthy. Accessed Feb. 23, 2017.
- Gaby AR. Intravenous nutrient therapy: The “Myers’ cocktail.” Altern Med Rev 2002;7:389-403.
- Padayatty SJ, Sun AY, Chen Q, et al. Vitamin C: Intravenous use by complementary and alternative medicine practitioners and adverse effects. PLoS One 2010;5:e11414. doi: 10.1371/journal.pone.0011414.
- Dalton W. Massive doses of vitamin C in the treatment of viral diseases. J Indiana State Med Assoc 1962;1151-1154.
- Ali A, Njike VY, Northrup V, et al. Intravenous micronutrient therapy (Myers’ Cocktail) for fibromyalgia: A placebo-controlled pilot study. J Altern Complement Med 2009;15:247-257.
- Shan Z, Rong Y, Yang W, et al. Intravenous and nebulized magnesium sulfate for treating acute asthma in adults and children: A systematic review and meta-analysis. Respir Med 2013;107:321-330.
- Kew KM, Kirtchuk L, Michell CI. Intravenous magnesium sulfate for treating adults with acute asthma in the emergency department. Cochrane Database Syst Rev 2014;(5):CD010909.
- Cameron E, Pauling L. Supplemental ascorbate in the supportive treatment of cancer: Prolongation of survival times in terminal human cancer. Proc Natl Acad Sci U S A 1976;73:3685-3789.
- Ried K, Travica N, Sali A. The acute effect of high-dose intravenous vitamin C and other nutrients on blood pressure: A cohort study. Blood Press Monit 2016;21:160-167.
- High-Dose Vitamin C. Available at: https://www.cancer.gov/about-cancer/treatment/cam/hp/vitamin-c-pdq#section/3. Accessed March 10, 2017.
- Wilson MK, Baguley BC, Wall C, et al. Review of high-dose intravenous vitamin C as an anticancer agent. Asia Pac J Clin Oncol 2014;10;22-37.
- ClinicalTrials.gov. Available at: https://clinicaltrials.gov/ct2/results?term=intravenous%2Bascorbic%2Bacid&Search=Search. Accessed March 10, 2017
- Rees DC, Kelsey H, Richards JD. Acute haemolysis induced by high dose ascorbic acid in glucose-6-phosphate dehydrogenase deficiency. BMJ 1993;306:841-842.
- Lawton JM, Conway LT, Crosson JT, et al. Acute oxalate nephropathy after massive ascorbic acid administration. Arch Intern Med 1985;145:950-951.
- Wong K, Thomson C, Bailey RR, et al. Acute oxalate nephropathy after a massive intravenous dose of vitamin C. Aust N Z J Med 1994;24:410-411.
- McAllister CJ, Scowden EB, Dewberry FL, Richman A. Renal failure secondary to massive infusion of vitamin C. JAMA 1984;252:1684.
- Bromley J, Hughes BG, Leong DC, Buckley NA. Life-threatening interaction between complementary medicines: Cyanide toxicity following ingestion of amygdalin and vitamin C. Ann Pharmacother 2005;39:1566-1569.
Intravenous nutrient therapies are gaining in popularity to help patients maintain overall wellness, enhance weight loss, boost immune function, increase athletic performance, cure hangovers, and treat particular conditions. However, the increase in the use of these therapies in both healthy individuals and those with health conditions has not translated into increased published research studies investigating efficacy and safety.
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