Pronunciation:

(AL koe hol, ETH il)

U.S. Brand Names:

Synonyms:

Generic Available:

Canadian Brand Names:

Use:

Use - Unlabeled/Investigational:

Pregnancy Risk Factor:

Pregnancy Implications:

Lactation:

Contraindications:

Warnings/Precautions:

Use with caution in diabetics (ethyl alcohol decreases blood sugar), hepatic impairment, patients with gout, shock, following cranial surgery, and in anticipated postpartum hemorrhage; monitor blood glucose closely, particularly in children as treatment of ingestions is associated with hypoglycemia; avoid extravasation during I.V. administration; ethyl alcohol passes freely into breast milk at a level approximately equivalent to maternal serum level; minimize dermal exposure of ethyl alcohol in infants as significant systemic absorption and toxicity can occur.

Adverse Reactions:

Central nervous system: Disorientation, encephalopathy, flushing, sedation, seizures (rare), vertigo

Endocrine & metabolic: Hypoglycemia

Genitourinary: Urinary retention

Local: Nerve and tissue destruction

Miscellaneous: Intoxication

Mechanism of Action:

Pharmacodynamics/Kinetics:

Duration: Vd: 0.6-0.7 L/kg; decreased in women

Absorption: Oral: Rapid

Metabolism: Hepatic (90% to 98%) to acetaldehyde or acetate

Half-life elimination: Rate of elimination: 15-20 mg/dL/hour (range: 10-34 mg/dL/hour); increased in alcoholics

Excretion: Kidneys and lungs (~2% unchanged)

Dosage:

Treatment of methanol or ethylene glycol ingestion (unlabeled use): Children and Adults: Absolute ethanol (86 proof = 34 g EtoH/dL)/ethyl alcohol: Note: Continue until methanol or ethylene glycol are no longer detected or<20 mg/dL and metabolic acidosis is corrected:

Oral: Note: Oral dosing is not recommended outside of a hospital setting: Initial dose: 600 mg/kg [equivalent to 1.8 mL/kg using a 43% solution]

Maintenance dose:

Nondrinker: 66 mg/kg/hour [equivalent to 0.2 mL/kg/hour using a 43% solution]

Chronic drinker: 154 mg/kg/hour [equivalent to 0.46 mL/kg/hour using a 43% solution]

Dosage adjustment for hemodialysis: Maintenance dose:

Nondrinker: 169 mg/kg/hour [equivalent to 0.5 mL/kg/hour using a 43% solution]

Chronic drinker: 257 mg/kg/hour [equivalent to 0.77 mL/kg/hour using a 43% solution]

I.V.: Initial dose: 600 mg/kg [equivalent to 7.6 mL/kg using a 10% solution]

Maintenance dose:

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]

Treatment of fat occlusion of central venous catheters (unlabeled use): Children and Adults: 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: Children and Adults: Liquid denatured alcohol: Topical: Apply 1-3 times/day as needed

Therapeutic neurolysis (nerve or ganglion block): Adults: Dehydrated alcohol injection: 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: Adults: Dehydrated alcohol infusion: Alcohol 5% and dextrose 5%: 1-2 L/day by slow infusion

Administration:

Oral: Ethylene glycol or methanol poisoning: Dilute ethyl alcohol to 20% solution and administer hourly via NG tube; oral treatment is not recommended outside of a hospital setting

I.V.: Ethylene glycol or methanol poisoning: 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

Monitoring Parameters:

Reference Range:

Additional Information:

Neurolytic block: Pain will occur after initial injection for a short period of time and will subside when neurolysis occurs; agent will destroy nerve and should be administered when pain is from malignant origin only; administer carefully.

Replenishment of fluid and carbohydrate calories: If the daily fluid requirement is >3 L/day, use of alcohol 5% in dextrose 5% is not recommended.

Undiluted ethanol 86 proof = 43% oral solution = 34 g ethanol/dL

I.V. solution 10% = 7.9 g ethanol/dL

Anesthesia and Critical Care Concerns/Other Considerations:

Neurolytic block: Pain will occur after initial injection for a short period of time and will subside when neurolysis occurs. This agent will destroy nerve and should be administered when pain is from malignant origin only; administer carefully.

Methanol/ethylene glycol poisoning: Treatment involves inhibiting the formation of toxic metabolites by inhibiting alcohol dehydrogenase and/or urgent dialytic removal of these alcohols and their metabolites. Fomepizole and ethanol are both inhibitors of alcohol dehydrogenase and have been used to prevent toxicity. Currently fomepizole is the drug of choice because of its ease of use and lack of CNS toxicity. When ethanol is used, a target serum level of 100-200 mg/dL is maintained during treatment. Patients are treated until serum levels of the poison (ethylene glycol/methanol) are <20 mg/dL.

Dental Health: Effects on Dental Treatment:

Dental Health: Vasoconstrictor/Local Anesthetic Precautions:

Mental Health: Effects on Mental Status:

Mental Health: Effects on Psychiatric Treatment:

Dosage Forms:

Infusion [in D5W, dehydrated]: Alcohol 5% (1000 mL); alcohol 10% (1000 mL)

Injection, solution [dehydrated]: 98% (1 mL, 5 mL)

Liquid, topical [denatured] (Lavacol®): 70% (473 mL)

International Brand Names: