| Mode Of Action | Ethanol is a competitive inhibitor of alcohol dehyrogenase with the alcohol-based poisons. This competition reduces the rate of the formation of toxic metabolites of methanol and ethylene glycol. |
|---|---|
| Drug Indication | Acute methanol poisoning: Acute ethylene glycol poisoning |
| Precautions | Chronic alcoholics may require higher doses of ethanol due to increased rate of metabolism (as results of enzyme induction) |
| Side Effects | Alcohol intoxication; sedation; ataxia; nausea; disorderly behaviour; hypoglycaemia and hiccups. |
| Special Information | An alcohol dehydrogenase inhibitor, fomepizole, has been introduced to replace alcohol in this role. Patients with serious acidosis may require vitamins to facilitate metabolism of the toxic products. For methanol poisoning 50mg folinic acid IV may be beneficial. For ethylene glycol poisoning 100mg of Vitamin B1 (thiamine) together with 50mg pyridoxine 6 hourly may also be useful. |
Ethanol may be confused with Ethyol®, Ethamolin®
Antiseptic: Liquid denatured alcohol: Topical: Apply 1-3 times/day as needed
Therapeutic neurolysis (nerve or ganglion block): Dehydrated alcohol injection 98%: Intraneural: Dosage variable depending upon the site of injection (eg, trigeminal neuralgia: 0.05-0.5 mL as a single injection per interspace vs subarachnoid injection: 0.5-1 mL as a single injection per interspace); single doses >1.5 mL are seldom required
Replenishment of fluid and carbohydrate calories: Dehydrated alcohol infusion: Alcohol 5% and dextrose 5%: 1-2 L/day by slow infusion
Septal ablation for HOCM (unlabeled use; Maron, 2003): Intracoronary (via balloon catheter): Dosage variable depending on septal anatomy and rate of contrast wash-out: 1-3 mL of at least 95% concentration infused slowly into septal perforator. Note: Smaller amounts may reduce the size of the septal infarct and incidence of complications (eg, complete heart block).
Treatment of methanol or ethylene glycol ingestion (unlabeled use): Note: I.V. administration is the preferred route; continue therapy until ethylene glycol and/or methanol is no longer detected or levels are <20 mg/dL and the patient is asymptomatic and metabolic acidosis has been corrected. If ethylene glycol and/or methanol levels are not available in a timely manner, continue therapy until the estimated time of clearance of ethylene glycol and/or methanol has elapsed and the patient is asymptomatic with a normal pH. If patient has coingested ethanol, measure the baseline serum ethanol concentration and adjust the ethyl alcohol loading dose based on results to achieve a serum ethanol level of ~100 mg/dL.
Absolute ethyl alcohol [98% (196 proof) = 77.4 g EtOH/dL]:
I.V.:
Initial: 600-700 mg/kg [equivalent to 7.6-8.9 mL/kg using a 10% solution]
Maintenance: Goal of therapy is to maintain serum ethanol levels >100 mg/dL.
Nondrinker: 66 mg/kg/hour [equivalent to 0.83 mL/kg/hour using a 10% solution]
Chronic drinker: 154 mg/kg/hour [equivalent to 1.96 mL/kg/hour using a 10% solution]
Dosage adjustment for hemodialysis: Maintenance dose:
Nondrinker: 169 mg/kg/hour [equivalent to 2.13 mL/kg/hour using a 10% solution]
Chronic drinker: 257 mg/kg/hour [equivalent to 3.26 mL/kg/hour using a 10% solution]
Oral: Solution must be diluted to a ≤20% concentration with water or juice and administered orally or via a nasogastric tube.
Initial: 600-700 mg/kg [equivalent to 0.78-0.9 mL/kg using a 98% solution]
Maintenance: Goal of therapy is to maintain serum ethanol levels >100 mg/dL
Nondrinker: 66 mg/kg/hour [equivalent to 0.09 mL/kg/hour using a 98% solution]
Chronic drinker: 154 mg/kg/hour [equivalent to 0.20 mL/kg/hour using a 98% solution]
Dosage adjustment for hemodialysis: Maintenance dose:
Nondrinker: 169 mg/kg/hour [equivalent to 0.22 mL/kg/hour using a 98% solution]
Chronic drinker: 257 mg/kg/hour [equivalent to 0.33 mL/kg/hour using a 98% solution]
Treatment of fat occlusion of central venous catheters (unlabeled use): Dehydrated alcohol injection: I.V. (see institutional-based protocol for catheter clearance assessment, the following assessment is a general methodology): Up to 3 mL of ethanol 70% (maximum: 0.55 mL/kg); the volume to instill is equal to the internal volume of the catheter
Antiseptic: Liquid denatured alcohol: Refer to adult dosing.
Treatment of methanol or ethylene glycol ingestion (unlabeled use): Refer to adult dosing.
Treatment of fat occlusion of central venous catheters (unlabeled use): Dehydrated alcohol injection: Refer to adult dosing.
Refer to adult dosing.
Treatment of methanol or ethylene glycol ingestion (unlabeled use): Absolute ethyl alcohol: Dosage adjustment for hemodialysis: Maintenance dose:
I.V.:
Nondrinker: 169 mg/kg/hour [equivalent to 2.13 mL/kg/hour using a 10% solution]
Chronic drinker: 257 mg/kg/hour [equivalent to 3.26 mL/kg/hour using a 10% solution]
Oral:
Nondrinker: 169 mg/kg/hour [equivalent to 0.22 mL/kg/hour using a 98% solution]
Chronic drinker: 257 mg/kg/hour [equivalent to 0.33 mL/kg/hour using a 98% solution]
Oral: Ethylene glycol or methanol poisoning: Dilute ethyl alcohol to ≤20% solution with water or juice and administer hourly by mouth or via nasogastric tube. Out-of-hospital management with orally-administered ethanol is not recommended.
I.V.: Ethylene glycol or methanol poisoning: I.V. administration is the preferred route. Administer as a 10% solution in D5W. Initial dose should be administered over 1 hour.
Treatment of occluded central venous catheter: Instill a 70% solution with a volume equal to the internal volume of the catheter. Assess patency at 30-60 minutes (or per institutional protocol).
Intraneural: Separate needles should be used for each of multiple injections or sites to prevent residual alcohol deposition at sites not intended for tissue destruction. Inject slowly after determining proper placement of needle. Since dehydrated alcohol is hypobaric when compared with spinal fluid, proper positioning of the patient is essential to control localization of injections into the subarachnoid space.
Topical anti-infective; pharmaceutical aid; therapeutic neurolysis (nerve or ganglion block); replenishment of carbohydrate calories
Antidote for ethylene glycol overdose; antidote for methanol overdose; treatment of fat occlusion of central venous catheters; septal ablation for hypertrophic obstructive cardiomyopathy (HOCM)
Frequency not defined.
Cardiovascular: Flushing, hypotension
Central nervous system: Disorientation, encephalopathy, sedation, seizure (rare), vertigo
Endocrine & metabolic: Hypoglycemia
Genitourinary: Urinary retention
Local: Nerve and tissue destruction
Miscellaneous: Intoxication
Hypersensitivity to ethyl alcohol or any component of the formulation; seizure disorder and diabetic coma; subarachnoid injection of dehydrated alcohol in patients receiving anticoagulants; pregnancy (prolonged use or high doses at term)
Disease-related concerns:
• Diabetes: Use with caution in patients with diabetes mellitus; ethyl alcohol may decrease blood sugar.
• Gout: Use with caution in patients with gout.
• Hepatic impairment: Use with caution in patients with hepatic impairment.
• Shock: Use with caution in patients with shock.
Special populations:
• Cranial surgery: Use with caution in patients following cranial surgery.
• Infants: Minimize dermal exposure of ethyl alcohol in infants as significant systemic absorption and toxicity can occur. Ethyl alcohol passes freely into breast milk at a level approximately equivalent to maternal serum level.
• Pregnancy: Use with caution in pregnant women with anticipated postpartum hemorrhage.
Other warnings/precautions:
• Administration: Proper positioning of the patient for neurolytic administration is essential to control localization of the injection of dehydrated alcohol (which is hypobaric) into the subarachnoid space; avoid extravasation. Not for SubQ administration. Do not administer simultaneously with blood due to the possibility of pseudoagglutination or hemolysis; may potentiate severe hypoprothrombic bleeding. Avoid extravasation during I.V. administration.
• Monitoring: Clinical evaluation and periodic lab determinations, including serum ethanol levels, are necessary to monitor effectiveness, changes in electrolyte concentrations, and acid-base balance (when used as an antidote). Monitor blood glucose closely, particularly in children as treatment of ingestions is associated with hypoglycemia.
• Proper storage: Flammable liquid and should be kept cool and away from any heat source.
Acitretin: Alcohol (Ethyl) may enhance the teratogenic effect of Acitretin. Risk X: Avoid combination
BuPROPion: Alcohol (Ethyl) may enhance the adverse/toxic effect of BuPROPion. Specifically, seizure threshold may be lowered. BuPROPion may enhance the adverse/toxic effect of Alcohol (Ethyl). Specifically, alcohol tolerance may decrease during treatment. Management: Patients receiving bupropion should be advised to minimize or avoid alcohol consumption due to possible lower alcohol tolerance, and lower seizure threshold associated with heavy alcohol consumption/abrupt discontinuation of heavy consumption.Risk D: Consider therapy modification
CefoTEtan: May enhance the adverse/toxic effect of Alcohol (Ethyl).Risk C: Monitor therapy
CNS Depressants: May enhance the CNS depressant effect of Alcohol (Ethyl).Exceptions: Levocabastine (Nasal).Risk C: Monitor therapy
CycloSERINE: Alcohol (Ethyl) may enhance the neurotoxic effect of CycloSERINE. Specifically, the risk for seizures may be increased. Risk X: Avoid combination
Didanosine: Alcohol (Ethyl) may enhance the adverse/toxic effect of Didanosine. Specifically, the risk of pancreatitis may be increased. Risk X: Avoid combination
Disulfiram: May enhance the adverse/toxic effect of Alcohol (Ethyl). A disulfiram-like reaction may occur.Risk X: Avoid combination
Ethionamide: Alcohol (Ethyl) may enhance the adverse/toxic effect of Ethionamide. Specifically, there may be a risk for a psychotic episode/reaction. Risk C: Monitor therapy
Griseofulvin: May enhance the adverse/toxic effect of Alcohol (Ethyl). A disulfiram-like reaction may occur.Risk C: Monitor therapy
ISOtretinoin: Alcohol (Ethyl) may enhance the adverse/toxic effect of ISOtretinoin. Specifically, the risk for elevated triglyceride concentrations may be increased. Risk C: Monitor therapy
MetroNIDAZOLE: May enhance the adverse/toxic effect of Alcohol (Ethyl). A disulfiram-like reaction may occur.Risk C: Monitor therapy
MetroNIDAZOLE (Systemic): May enhance the adverse/toxic effect of Alcohol (Ethyl). A disulfiram-like reaction may occur.Risk C: Monitor therapy
MetroNIDAZOLE (Topical): May enhance the adverse/toxic effect of Alcohol (Ethyl). A disulfiram-like reaction may occur.Risk C: Monitor therapy
NIFEdipine: Alcohol (Ethyl) may increase the serum concentration of NIFEdipine. Risk C: Monitor therapy
Phentermine: Alcohol (Ethyl) may enhance the adverse/toxic effect of Phentermine. Risk C: Monitor therapy
Propranolol: Alcohol (Ethyl) may decrease the serum concentration of Propranolol. Alcohol (Ethyl) may increase the serum concentration of Propranolol. Risk C: Monitor therapy
Selective Serotonin Reuptake Inhibitors: Alcohol (Ethyl) may enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Specifically, the risk of psychomotor impairment may be enhanced. Management: Patients receiving selective serotonin reuptake inhibitors should be advised to avoid alcohol. Monitor for increased psychomotor impairment in patients who consume alcohol during treatment with selective serotonin reuptake inhibitors.Risk D: Consider therapy modification
Serotonin/Norepinephrine Reuptake Inhibitors: Alcohol (Ethyl) may enhance the adverse/toxic effect of Serotonin/Norepinephrine Reuptake Inhibitors. Specifically, risks of psychomotor impairment may be enhanced. Alcohol (Ethyl) may enhance the hepatotoxic effect of Serotonin/Norepinephrine Reuptake Inhibitors. Particularly duloxetine and milnacipran. Management: Patients receiving serotonin/norepinephrine reuptake inhibitors (SNRIs) should be advised to avoid alcohol. Monitor for increased psychomotor impairment and hepatotoxicity in patients who consume alcohol during treatment with SNRIs.Risk D: Consider therapy modification
Sulfonylureas: May enhance the adverse/toxic effect of Alcohol (Ethyl). A flushing reaction may occur.Risk C: Monitor therapy
Tacrolimus: May enhance the dermatologic adverse effect of Alcohol (Ethyl).Risk C: Monitor therapy
Tacrolimus (Topical): May enhance the dermatologic adverse effect of Alcohol (Ethyl).Risk C: Monitor therapy
Thiazide Diuretics: Alcohol (Ethyl) may enhance the orthostatic hypotensive effect of Thiazide Diuretics. Risk C: Monitor therapy
Trabectedin: Alcohol (Ethyl) may enhance the hepatotoxic effect of Trabectedin. Risk X: Avoid combination
Verapamil: May increase the serum concentration of Alcohol (Ethyl).Risk C: Monitor therapy
C (injection) (show table)
Reproduction studies have not been conducted with alcohol injection. Ethanol crosses the placenta, enters the fetal circulation, and has teratogenic effects in humans. The following withdrawal symptoms have been noted in the neonate following maternal ethanol consumption during pregnancy: Crying, hyperactivity, irritability, poor suck, tremors, seizures, poor sleeping pattern, hyperphagia, and diaphoresis. Fetal alcohol syndrome (FAS) is a term referring to a combination of physical, behavioral, and cognitive abnormalities resulting from ethanol exposure during fetal development. Since a “safe” amount of ethanol consumption during pregnancy has not been determined, the AAP recommends those women who are pregnant or planning a pregnancy refrain from all ethanol intake. When used as an antidote during the second or third trimester, FAS is not likely to occur due to the short treatment period; use during the first trimester is controversial.
Enters breast milk (AAP rates “compatible”; AAP 2001 update pending)
Ethanol is found in breast milk. Drowsiness, diaphoresis, deep sleep, weakness, decreased linear growth, and abnormal weight gain have been reported in infants following large amounts of ethanol ingestion by the mother. Ingestion >1 g/kg/day decreases milk ejection reflex. The actual clearance of ethanol from breast milk is dependent upon the mother's weight and amount of ethanol consumed.
Antidotal therapy: Blood ethanol levels every 1-2 hours until steady state, then every 2-4 hours; blood glucose, electrolytes (including serum magnesium), arterial pH, blood gases, methanol or ethylene glycol blood levels; heart rate, blood pressure
Antidote for methanol/ethylene glycol: Blood ethanol level: Goal range: 100-150 mg/dL
When used to treat ethylene glycol or methanol toxicity, ethyl alcohol competitively inhibits alcohol dehydrogenase, an enzyme which catalyzes the metabolism of ethylene glycol and methanol to their toxic metabolites.
Absorption: Oral: Rapid
Distribution: Vd: 0.6-0.7 L/kg; decreased in women
Metabolism: Hepatic (90% to 98%) to acetaldehyde or acetate
Half-life elimination: Rate: 15-20 mg/dL/hour (range: 10-34 mg/dL/hour); increased in alcoholics
Excretion: Kidneys and lungs (~2% unchanged)