IV Drip Therapy: An Evidence Guide for Clinics in Pakistan

In short: the strong evidence for intravenous nutrients sits in documented deficiency, clinical nutrition and hospital care. For elective drips in well patients the controlled evidence is thin, and some trials in sick patients found no benefit and others a safety signal.

Reading the evidence on IV drips

An IV drip is an intravenous infusion of fluid, vitamins, minerals, amino acids or other nutrients in a sterile solution. Bypassing the gut raises blood levels faster and higher than the same nutrient taken by mouth. That is pharmacokinetics, not clinical benefit: whether a higher level does anything useful depends on the patient, the nutrient and the question being asked.

Most of what is known about intravenous nutrients comes from two settings: correcting a documented deficiency, and supporting patients who cannot be fed by mouth or tube. Far less comes from elective infusions in otherwise well people, the setting clinics ask about most. This guide therefore grades each class twice, using four plain labels.

• Established: guideline-supported use in a defined clinical setting.
• Mixed: randomised trials with inconsistent results or a safety signal.
• Limited: small or uncontrolled studies only.
• Insufficient: no adequate controlled human data for the intravenous route.

The grades are our own reading of the published literature, not a regulatory finding or clinical recommendation, and they say nothing about any individual product.

Formulation classes and their evidence

The table summarises the grades; each class is then discussed with its studies, limits and safety signals. No doses or regimens are given anywhere in this guide; dosing belongs in product labelling and the treating physician's judgement.

Vitamin C (sodium ascorbate)

Evidence. Intravenous vitamin C is an established option for scurvy (see vitamin C in the Knowledge Base). In critically ill adults the record is mixed. CITRIS-ALI (Fowler et al., JAMA 2019; 167 patients with sepsis and acute respiratory distress syndrome) found no difference in its prespecified organ-failure and inflammatory-marker outcomes; lower 28-day mortality was an exploratory secondary finding. The larger LOVIT trial (Lamontagne et al., NEJM 2022; 872 adults with sepsis on vasopressors) found death or persistent organ dysfunction at 28 days more often with vitamin C than with placebo, 44.5% against 38.5%.

For elective use there is one small randomised trial in 141 healthy office workers (Suh et al., Nutrition Journal 2012), reporting lower fatigue scores after the infusion, with very short follow-up. We found no independent replication.

Limits and safety. The FDA label for intravenous ascorbic acid warns of oxalate nephropathy, of haemolysis in patients with G6PD (glucose-6-phosphate dehydrogenase) deficiency, and of inaccurate blood and urine glucose test results around the time of an infusion, so renal function and G6PD status deserve attention beforehand.

B vitamins, vitamin B12 and folate

Evidence. Parenteral B vitamins and folate are established where a deficiency is documented, and are a standard part of parenteral nutrition (ESPEN micronutrient guideline, Berger et al., Clinical Nutrition 2022). The route matters for vitamin B12: a Cochrane review (Wang et al., 2018; three trials, 153 participants) found oral and intramuscular B12 gave comparable serum B12 levels in deficiency, and cyanocobalamin injection labels advise against the intravenous route because most of the vitamin is lost in the urine. See vitamin B12, folate and the B-complex in the Knowledge Base.

For mixed-vitamin infusions in well patients, the one placebo-controlled trial we found was a pilot of a Myers-type vitamin and mineral infusion in 34 adults with fibromyalgia (Ali et al., Journal of Alternative and Complementary Medicine 2009): both groups improved, with no statistically significant difference between them.

Limits and safety. Thiamine injection labels warn of serious hypersensitivity reactions, including deaths, especially after repeat exposure, so a site infusing B vitamins needs anaphylaxis preparedness.

Amino acids

Evidence. Intravenous amino acids are established in parenteral nutrition; outside it, results depend on the mixture and the patient. In the PROTECTION trial (Landoni et al., NEJM 2024; 3,511 adults having cardiac surgery) a balanced amino acid infusion lowered acute kidney injury, 26.9% against 31.7%. In the REDOXS trial (Heyland et al., NEJM 2013; 1,223 critically ill adults with multiple organ failure), glutamine given intravenously and enterally was associated with higher in-hospital and six-month mortality. "Amino acids" is not one intervention. See glutamine, arginine, taurine and glycine in the Knowledge Base.

Limits and safety. Both trials enrolled hospital patients under close monitoring; neither supports elective use. Parenteral amino acid labels list contraindications or cautions that include inborn errors of amino acid metabolism, hepatic coma and severe renal impairment.

Glutathione

Evidence. Glutathione is the main intracellular antioxidant tripeptide (see glutathione and cysteine in the Knowledge Base). Intravenous use has been tested only in small trials: a randomised, placebo-controlled pilot in 21 people with a neurodegenerative movement disorder (Hauser et al., Movement Disorders 2009) found the infusions well tolerated but no significant difference on its rating-scale outcomes. We found no large controlled trial of intravenous glutathione for cosmetic purposes.

Limits and safety. In July 2019 the Philippines FDA (Advisory No. 2019-182) stated that it had approved no injectable glutathione product for cosmetic use, noted that no published trials had evaluated it for that purpose, and warned of possible liver, kidney and nervous-system toxicity, severe skin reactions and infection risk when infusions are given in non-sterile settings.

NAD+

Evidence. NAD+ is a coenzyme with a well-characterised role in cellular energy metabolism (see NAD+ in the Knowledge Base). Human data on infusing NAD+ itself are scarce; most work on raising NAD+ uses oral precursors. A 2019 pilot in 11 participants (Grant et al., Frontiers in Aging Neuroscience) found that infused NAD+ was removed from plasma without a measurable rise in the early part of the infusion. A 2024 randomised pilot posted as a preprint (Hawkins et al., medRxiv; not peer reviewed when we checked, and testing a commercial nicotinamide riboside product) found intravenous nicotinamide riboside raised blood NAD+ more than intravenous NAD+. We found no randomised trial of intravenous NAD+ for any clinical or ageing outcome.

Limits and safety. In a 2026 retrospective review of clinic records (Reyna et al., Frontiers in Aging), intravenous NAD+ (6 clients) was linked to moderate to severe gastrointestinal symptoms, a faster pulse and chest pressure during infusion, and infusions took substantially longer than with nicotinamide riboside (8 clients); the groups were very small and the design was retrospective.

Minerals: magnesium, zinc and selenium

Evidence. Zinc and selenium are given intravenously as trace elements in parenteral nutrition (ESPEN micronutrient guideline, 2022), and magnesium has defined hospital uses under monitoring. We found no adequate controlled trial of elective outpatient mineral infusions in well patients. Limits and safety. Magnesium is cleared by the kidney; product labels warn of toxicity in renal impairment, of hypotension and of flushing.

Clinical governance for an IV service

General information from public sources, not legal advice; requirements differ by province. Confirm current rules with the regulator and your legal adviser.

• A licensed physician. An infusion is a medical procedure, prescribed and supervised by a physician registered with the Pakistan Medical and Dental Council, who assesses each patient (allergies, renal and hepatic function, current medicines) and owns the decision to infuse.
• A licensed healthcare establishment. Provincial healthcare commissions license clinics (Punjab, Sindh and Khyber Pakhtunkhwa), and in Islamabad the Islamabad Healthcare Regulatory Authority. Press reports in 2025 and 2026 describe commissions sealing unlicensed clinics, so check that your licence covers the services you offer.
• Registered medicines. Injectable vitamins, amino acids and similar preparations fall within the DRAP Act 2012 definition of a drug. A medicine must be registered with DRAP before it is imported or supplied, unless DRAP has granted a specific exemption.
• Compliant communication. Advertising of therapeutic goods needs prior permission under the Therapeutic Goods (Advertisement) Rules, 2025, which DRAP announced in February 2026 it was enforcing. Under DRAP's advertisement guidelines, even stating on a clinic website that a named prescription medicine is available at the clinic counts as advertising.
• Sterile practice and records. Aseptic preparation, single-use sets, storage as labelled, batch records, anaphylaxis training and resuscitation equipment on site (good clinical practice); suspected adverse reactions go to DRAP's National Pharmacovigilance Centre.

What to ask a supplier

A clinic relies on its supplier for the legal status, quality and storage of what it infuses. Before ordering anything, ask for:

1. The DRAP registration number, with the registered name, strength and holder. Check it against DRAP's searchable list (Registered Product Data at eapp.dra.gov.pk); DRAP calls the list provisional, so also ask for the registration certificate.
2. The Drug Sale Licence and, for imports, the importer's authorisation agreement with the manufacturer.
3. A batch certificate of analysis and the manufacturer's GMP certificate.
4. Storage and transport conditions, with evidence that the cold chain was kept.
5. Labelling that identifies product, manufacturer, batch and expiry and traces back to the registration.
6. Written product information, including contraindications and adverse reactions, not marketing claims.

Be cautious of any offer of "imported" infusion products without a DRAP registration number; press reports in April 2026 said DRAP had asked the Pakistan Telecommunication Authority to block websites that sell or promote unregistered therapeutic products.

EFBA is a manufacturer, not a supplier in Pakistan. IVIXIR products do not currently hold a DRAP registration, and IVIXIR products are supplied in Pakistan only after DRAP registration through a licensed importer; samples are not offered via this website. The formulations EFBA makes are listed in the catalogue (a short healthcare-professional confirmation applies); licensed importers can read about the registration and distribution partnership.