Introducing IVNT to your clinic

By Dr Jacques Otto and Dr Samantha Gammell / 11 May 2016

Dr Jacques Otto and Dr Samantha Gammell discuss the rise in intravenous nutritional therapy’s popularity and detail how you can incorporate this safely into your clinic

Growth of IVNT in the UK

In the 1960s, Dr John Myers, a physician from Baltimore, pioneered the use of intravenous (IV) vitamins and minerals as part of the overall treatment of various medical conditions such as acute asthma attacks, migraines, fatigue (including chronic fatigue syndrome), fibromyalgia, acute muscle spasm, upper respiratory tract infections, chronic sinusitis, seasonal allergic rhinitis, cardiovascular disease, and other disorders.1 However, the acceptance and popularity of intravenous nutritional therapy (IVNT) in North America, South America, the Middle East and the Far East is owed to Dr Alan R Gaby, who took over the care of the late Dr Myers’s patients in 1984 and continued to treat various medical conditions using his modified Myers’ Cocktail.1 Since this time, more recent advances in IVNT include the addition of amino acids to the modified Myers’ Cocktail. IVNT had been practically non-existent in the UK until 2014. However, a change was illustrated in the summer of 2015, when aesthetic doctors, independent nurse prescribers and non-prescribing nurses participated in a survey. Surprisingly, 48% of respondents were providers of IVNT, and the results indicated that, “The most widely used brand by respondents was IntraVita, followed by Myers’ Cocktail, Reviv and VitaminDrip.”2 This shows the increase in popularity and availability of IVNT in the UK.

Regulation

At the beginning of 2015, the Medicines and Healthcare Products Regulatory Agency (MHRA) classified intravenous nutrition products as supplements and not medicines.3 As such, in the UK, medical claims cannot be made by practitioners or on their clinics’ websites. Instead, IVNT is largely offered to promote general health and wellbeing using different cocktails of vitamins, minerals and amino acids which aim to help boost one’s immunity,4,5 aid athletic performance,6 for re-energising,7-12 to assist with diet and detox, as an anti-oxidant booster,4 promotion of hair growth, and to lighten or whiten skin.13 In spite of this classification of IV nutrition products as supplements in the UK, there are thousands of publications in the PubMed.gov archives in support of IVNT for various medical conditions, which is why IVNT clinics are huge business in the US. The global market for parenteral nutrition is forecast to reach US $8.7 billion by 2020, driven by the growing popularity of home health nutrition therapy.14 According to the report by Global Industry Analysts, “The United States represents the largest market worldwide, led by aging population, increase in the number of chronic diseases such as cancer, AIDS and gastrointestinal disorders.”14

Demand

In the UK, demand for IVNT is increasing. For example, in the past year, our company, IntraVita, has reported an unprecedented increase in demand for the training and supply of IVNT products. In 2015, we trained more than 100 practitioners and it is estimated that this number will rise to more than 300 practitioners by the end of 2016. We believe that as many as 500 practitioners will be providing IVNT in their UK clinics by the end of 2017.15

Considerations

If you choose to incorporate IVNT in your clinic, it is important to consider the following important factors when choosing a trainer and supplier of INVT products. 

  1. Products should be manufactured in an EU Good Manufacturing Practice (GMP) manufacturing facility. US Food and Drug Administration approved products are not legal in the EU, unless the MHRA has approved a manufacturer’s license. According to the MHRA, ‘To make, assemble or import human medicines, you need a manufacturer licence, issued by the MHRA. To qualify for a manufacturer licence you need to show MHRA that you comply with EU GMP and pass regular GMP inspections of your site.’16
  2. Products should be preservative free to minimise the risk of allergic reactions.17
  3. Ensure that your product supplier has Supplier’s Product Liability Insurance in place. Cosmetic or aesthetic insurance companies do not necessarily cover product liability.
  4. Post-training support by suppliers.
  5. Practitioner’s insurance cover that includes IVNT is available.
  6. Reliable IVNT product suppliers that carry large stock inventories to ensure timeous product delivery.
  7. Calculated safe osmolarities for each IVNT protocol or ‘cocktail’ to avoid potential complications.
  8. Proper training should be available from a qualified medical practitioner. It is also important to note that the ideal clinical setting for the provision of an IVNT service is similar to most aesthetic clinics, with a properly trained and insured practitioner who has valid basic life support and anaphylaxis training. 

Training

A general misconception among practitioners is that vitamins, minerals and amino acids are basic nutrients and they therefore do not require in-depth training. As with all treatments, however, the safety comes from understanding and avoiding the risks and potential side effects. IVNT training should include:

  1. The mechanism of action of each nutrient: minerals, vitamins and amino acids.
  2. The safety of IVNT, including the management of potential adverse events.
  3. How to consult and consent patients, and how to document the treatment.
  4. How to correctly calculate the osmolarity of each ‘cocktail’.
  5. How to correctly prepare each ‘cocktail’ of vitamins, minerals and amino acids.
  6. The practical aspects of IVNT, including setting up drips and calculating drip rates.
  7. The training company should provide IVNT protocols for practitioners to use in their clinics.
  8. Literature references.

How to market to patients

Patients are often surprisingly well informed about IVNT and many patients are already seeking out clinics that offer treatments. For those less informed, information on your website, blog and an introductory email to your patient base is a simple and effective marketing tool. Social media marketing using Facebook and Twitter is also essential and can dramatically increase your patient footfall. An open evening introducing IVNT is also recommended so a group of select patients can be informed about IVNT in a short period of time and be offered an introductory discount.

We recommend that IVNT should be promoted as a package of six treatments: the first few treatments done weekly and then fortnightly to achieve maximum results 

Packages

We recommend that IVNT should be promoted as a package of six treatments: the first few treatments done weekly and then fortnightly to achieve maximum results. Maintenance treatments are normally 8-12 weeks but typically the patient will know or feel when they need a top-up treatment. One-off treatments are not advisable because in some cases it may take two-to-three treatments to reverse deficiencies.

Conclusion 

It is without a doubt that IVNT popularity has increased in the UK, and, as mentioned earlier, we predict that clinics offering this treatment will increase to 500 by the end of 2017. If you do choose to incorporate this treatment, it is imperative that you choose an appropriate trainer and supplier, and fully understand the different products and risks associated with administering these.

In our next article, we will explore the important clinical factors you need to consider when introducing IVNT to your practice. 

Disclosure: In 2014, Dr Samantha Gammell and Dr Jacques Otto, together with aesthetic distributor Mr Vernon Otto, founded IntraVita Ltd. They now teach and train other medical practitioners in IVNT use. 

References

  1. Gaby Alan R, ‘Intravenous Nutrient Therapy “The Myers’ Cocktail”, Alternative Medical Review, 7 (2002), pp.389-403.
  2. Jackson Lorna, Intravenous Vitamin Infusions Fad or Fabulous? (2015).
  3. MHRA Letter to IntraVita Ltd. (28 August 2015) Data on file – all queries welcome.
  4. Blanchard J, Tozer TN, Rowland M., ‘Pharma-cokinetic perspectives on megadoses of ascorbic acid’, Am J Clin Nutr 66 (1997), pp.1165-1171.
  5. Harakeh S, Jariwalla RJ, Pauling L., ‘Suppression of human immunodeficiency virus replication by ascorbate in chronically and acutely infected cells’, Proc Natl Acad Sci USA, 87 (1990), pp.7245- 7249.
  6. Newhouse IJ, Finstad EW., ‘The effects of magnesium supplementation on exercise performance’, Clin J Sport Med, 10 (2000), pp.195-200.
  7. Rosenbaum EE, Portis S, Soskin S., ‘The relief of muscular weakness by pyridoxine hydro- chloride’, J Lab Clin Med 27 (1941), pp.763-770.
  8. Cox IM, Campbell MJ, Dowson D., ‘Red blood cell magnesium and chronic fatigue syndrome’, Lancet 337 (1991), pp.757-760.
  9. Howard JM, Davies S, Hunnisett A., ‘Magnesium and chronic fatigue syndrome’, Lancet, 340 (1992), p.426.
  10. Clague JE, Edwards RH, Jackson MJ., ‘Intravenous magnesium loading in chronic fatigue syndrome’, Lancet, 340 (1992), pp.124-125.
  11. Ellis FR, Nasser S., ‘A pilot study of vitamin B12 in the treatment of tiredness’, Br J Nutr, 30 (1973), pp.277-283.
  12. Lapp CW, Cheney PR., ‘The rationale for using high-dose cobalamin (vitamin B12)’, CFIDS Chronicle Physicians’ Forum, (1993), pp.19-20.
  13. Shimada Y, Tai H, Tanaka A, Ikezawa-Suzuki I, Takagi K, Yoshida Y, Yoshie H., ‘Effects of ascorbic acid on gingival melanin pigmentation in vitro and in vivo’, J Periodontol, 80 (2009), pp.317-23.
  14. Global Industry Analysts, Inc. Parenteral Nutrition Market Trends (US, Global Industry Analysts, 2015) <http://www.strategyr.com/Parenteral_Nutrition_Market_Report.asp>
  15. Data on file via IntraVita Ltd – all queries welcome.
  16. MHRA, Overview, manufacturer’s Licence (UK, MHRA, 2016) <https://www.gov.guidance/apply-for-manufacturer-or-wholesaler-of-medcines-licences>
  17. Medscape, Benzyl alcohol allergy: Importance of Patch Testing with Personal Products (2016) <ttp:// www.medscape.com/viewarticle/521354_3> 

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