Alcohols (medicine) explained

Drug Name:Alcohol
Width:175
Routes Of Administration:Topical, intravenous, by mouth
Class:Antiseptics, disinfectants, antidotes
Atc Prefix:D08
Atc Suffix:AX08
Atc Supplemental:,
Legal Us:OTC
Metabolism:Liver
Cas Number:64-17-5
Unii:3K9958V90M
Pubchem:702
Drugbank:DB00898
Chemspiderid:682

Alcohols, in various forms, are used medically as an antiseptic, disinfectant, and antidote. Alcohols applied to the skin are used to disinfect skin before a needle stick and before surgery. They may also be used as a hand sanitizer; to clean other areas;[1] and in mouthwashes.[2] [3] [4] Taken by mouth or injected into a vein, ethanol is used to treat methanol or ethylene glycol toxicity when fomepizole is not available.

Side effects of alcohols applied to the skin include skin irritation.[1] Care should be taken with electrocautery, as ethanol is flammable.[5] Types of alcohol used include ethanol, denatured ethanol, 1-propanol, and isopropyl alcohol.[6] [7] Alcohols are effective against a range of microorganisms, though they do not inactivate spores.[7] Concentrations of 60% to 90% work best.[7]

Uses

95% ABV ethanol is known as spiritus fortis in medical context.

Alcohol septal ablation

See main article: Alcohol septal ablation.

Ablysinol (a brand of 99% ethanol medical alcohol) was sold from $1,300 to $10,000 per 10-pack in 2020 due to FDA administrator action granting exclusivity when used for treating hypertrophic obstructive cardiomyopathy with alcohol septal ablation in the US through 2025, despite "misuse" of the orphan drug act.[8] [9] [10]

Antiseptics

Alcohols

Ethanol is listed under Antiseptics, and Alcohol based hand rub under Disinfectants, on the World Health Organization's List of Essential Medicines.[11]

Applied to the skin, alcohols are used to disinfect skin before a needle stick and before surgery.[1] They may be used both to disinfect the skin of the person and the hands of the healthcare providers.[1] They can also be used to clean other areas,[1] and in mouthwashes.[2]

Both ethanol and isopropyl alcohol are common ingredients in topical antiseptics, including hand sanitizer.[12]

Antidote

When taken by mouth or injected into a vein ethanol is used to treat methanol or ethylene glycol toxicity[13] when fomepizole is not available.[5]

Mechanism

Ethanol, when used for toxicity, competes with other alcohols for the alcohol dehydrogenase enzyme, lessening metabolism into toxic aldehyde and carboxylic acid derivatives, and reducing more serious toxic effect of the glycols to crystallize in the kidneys.[14]

Euthanasia

Alcohol can intensify the sedation caused by hypnotics/sedatives such as barbiturates, benzodiazepines, sedative antihistamines, opioids, nonbenzodiazepines/Z-drugs (such as zolpidem and zopiclone).[15]

In the Netherlands, pentobarbital is part of the standard protocol for physician-assisted suicide for self-administration by the patient.[16] It is given in liquid form, in a solution of sugar syrup and alcohol, containing 9 grams of pentobarbital. This is preceded by an antiemetic to prevent vomiting.[17]

Medicinal solvent

Ethanol, often in high concentrations, is used to dissolve many water-insoluble medications and related compounds. Liquid preparations of pain medications, cough and cold medicines, and mouth washes, for example, may contain up to 25% ethanol[18] and may need to be avoided in individuals with adverse reactions to ethanol such as alcohol-induced respiratory reactions.[19] Ethanol is present mainly as an antimicrobial preservative in over 700 liquid preparations of medicine including acetaminophen, iron supplements, ranitidine, furosemide, mannitol, phenobarbital, trimethoprim/sulfamethoxazole and over-the-counter cough medicine.[20]

Some medicinal solutions of ethanol are also known as tinctures.

Sclerosant

Absolute ethanol is used as a sclerosant in sclerotherapy. Sclerotherapy has been used "in the treatment of simple pleural effusions, vascular malformations, lymphocytes and seromas."[21]

Sedative

Ethchlorvynol, developed in the 1950s, was used to treat insomnia, but prescriptions for the drug had fallen significantly by 1990, as other hypnotics that were considered safer (i.e., less dangerous in overdose) became much more common. Also, ethchlorvynol is not compatible with intravenous injection like ethanol—serious injury (including the loss of limbs due to vascular injury) or death can occur when it is used in this manner.[22] It is no longer prescribed in the United States due to unavailability, but it is still available in some countries and would still be considered legal to possess and use with a valid prescription.

Society and culture

Unproven methods against COVID-19

Unproven COVID-19 prevention from alcohol consumption

Drinking alcohol will not prevent or cure COVID-19,[23] contrary to some claims.[24]

Unproven COVID-19 hand sanitizer

See main article: List of unproven methods against COVID-19.

Vodka was alleged to be an effective homemade hand sanitizer, or an ingredient in one. The company whose brand was alleged to be protective responded to the rumours by citing the US Centers for Disease Control and Prevention statement that hand sanitizers needed to be at least 60% alcohol to be effective, and stating that their product was only 40% alcohol.[25] [26]

History

See also: Medicinal Liquor Prescriptions Act of 1933.

Ancient world

Since antiquity, prior to the development of modern agents, alcohol was used as a general anesthetic.[27]

Beer is one of the earliest known ingredients for wound healing. A medical prescription from Mesopotamia describes a method for healing wounds:[28] [29]

Pound together fur-turpentine, pine-turpentine, tamarisk, daisy, flour of inninnu strain; mix in milk and beer in a small copper pan; spread on skin; bind on him, and he shall recover.

Late Middle Ages

Alcohol has been used as an antiseptic as early as 1363, with evidence to support its use becoming available in the late 1800s.[30]

Modern period

Early doctors recognized that ethanol was a risky anesthetic because it could lead to death from alcohol poisoning or vomit inhalation (pulmonary aspiration). This led to use of alternatives in antiquity, such as opium and cannabis, and later diethyl ether starting in the 1840s.[31] As safer options became available, ethanol was eventually phased out as a general anesthetic.

Methylpentynol, discovered 1913, prescribed for the treatment of insomnia, but its use was quickly phased out in response to newer drugs with far more favorable safety profiles.[32] [33] [34] The drug has been replaced by benzodiazepines and is no longer sold anywhere.[35]

Notes and References

  1. Book: WHO Model Formulary 2008 . 2009 . 9789241547659 . ((World Health Organization)) . Stuart MC, Kouimtzi M, Hill SR . 10665/44053 . World Health Organization . World Health Organization . 321.
  2. Book: Limeback H . Comprehensive Preventive Dentistry. 11 April 2012. John Wiley & Sons. 978-1-118-28020-1. 138–. live. https://web.archive.org/web/20170918190140/https://books.google.com/books?id=bar1W50pfgEC&pg=PA138. 18 September 2017.
  3. Book: Kuriakose MA . Contemporary Oral Oncology: Biology, Epidemiology, Etiology, and Prevention. 8 December 2016. Springer. 978-3-319-14911-0. 47–54. live. https://web.archive.org/web/20170918190141/https://books.google.com/books?id=qp-wDQAAQBAJ&pg=PA47. 18 September 2017.
  4. Jameel RA, Khan SS, Kamaruddin MF, Abd Rahim ZH, Bakri MM, Abdul Razak FB . Is synthetic mouthwash the final choice to treat oral malodour? . Journal of the College of Physicians and Surgeons—Pakistan . 24 . 10 . 757–762 . October 2014 . 25327922 . .
  5. Book: British National Formulary: BNF 69. 2015. British Medical Association. 9780857111562. 42, 838. 69th .
  6. Web site: WHO Model List of Essential Medicines (19th List). World Health Organization. 8 December 2016. April 2015. live. https://web.archive.org/web/20161213052708/http://www.who.int/medicines/publications/essentialmedicines/EML_2015_FINAL_amended_NOV2015.pdf?ua=1. 13 December 2016.
  7. McDonnell G, Russell AD . Antiseptics and disinfectants: activity, action, and resistance . Clinical Microbiology Reviews . 12 . 1 . 147–179 . January 1999 . 9880479 . 88911 . 10.1128/cmr.12.1.147 .
  8. News: Paavola . Alia . Why price of dehydrated alcohol is going from $1,300 to $10K . www.beckershospitalreview.com . 12 February 2020 .
  9. News: Biotech executives, having pledged fair pricing, criticize drugmaker for steep hike . BioPharma Dive.
  10. Web site: Statement on Belcher Pharmaceuticals . linkedin . 19 October 2023 .
  11. Book: ((World Health Organization)) . World Health Organization model list of essential medicines: 21st list 2019 . 2019 . 10665/325771 . World Health Organization . World Health Organization . Geneva . WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO . free .
  12. Research . Center for Drug Evaluation and . 2023-05-12 . Q&A for Consumers Hand Sanitizers and COVID-19 . FDA . en.
  13. Mégarbane . Bruno . 2010-08-24 . Treatment of patients with ethylene glycol or methanol poisoning: focus on fomepizole . Open Access Emergency Medicine . 2 . 67–75 . 10.2147/OAEM.S5346 . 1179-1500 . 4806829 . 27147840 . free .
  14. Barceloux DG, Bond GR, Krenzelok EP, Cooper H, Vale JA . American Academy of Clinical Toxicology practice guidelines on the treatment of methanol poisoning . Journal of Toxicology. Clinical Toxicology . 40 . 4 . 415–446 . 2002 . 12216995 . 10.1081/CLT-120006745 . 26495651 .
  15. Acute care for alcohol intoxication. https://web.archive.org/web/20101214113109/http://my.lecom.edu/library/internetresources/journal%20articles/Acute%20Care%20for%20Alcohol%20Intoxication.pdf. 14 December 2010. Postgraduate Medicine Online. Yost DA . 112. 6. 2002. 29 September 2007.
  16. Web site: Köhler W . 23 November 2000 . Euthanica . Euthanesia Dossier . NRC Webpagina's . nl.
  17. Web site: Köhler W . 23 November 2000 . Euthanica . Euthanesia Dossier . NRC Webpagina's . nl.
  18. Web site: Alcohol Content in Common Preparations . Medical Society of the State of New York . October 8, 2019 . 29 April 2021 . https://web.archive.org/web/20210429232655/https://www.mssny.org/App_Themes/MSSNY/pdf/AlcoholContent.pdf . dead .
  19. Adams KE, Rans TS . Adverse reactions to alcohol and alcoholic beverages . Annals of Allergy, Asthma & Immunology . 111 . 6 . 439–445 . December 2013 . 24267355 . 10.1016/j.anai.2013.09.016 .
  20. Zuccotti GV, Fabiano V . Safety issues with ethanol as an excipient in drugs intended for pediatric use . Expert Opinion on Drug Safety . 10 . 4 . 499–502 . July 2011 . 21417862 . 10.1517/14740338.2011.565328 . 41876817 .
  21. Episalla NC, Orra S, Black CK, Dekker PK, Kim KG, Cardella JT, Evans KK . Sclerotherapy as an alternative treatment for complex, refractory seromas . Journal of Surgical Case Reports . 2021 . 8 . rjab224 . August 2021 . 34447570 . 10.1093/jscr/rjab224 . Oxford University Press . 8384448 .
  22. Glauser FL, Smith WR, Caldwell A, Hoshiko M, Dolan GS, Baer H, Olsher N . Ethchlorvynol (Placidyl)-induced pulmonary edema . Annals of Internal Medicine . 84 . 1 . 46–48 . January 1976 . 942681 . 10.7326/0003-4819-84-1-46.
  23. Web site: Myth busters . who.int . World Health Organization . en.
  24. News: Baumgarten A . 10 common myths busted about coronavirus in North Dakota . 14 April 2020 . The Dickinson Press . en.
  25. Web site: Fact or Fiction: Tito's Vodka can be used in hand sanitizer?. March 10, 2020. KGTV. April 9, 2020.
  26. Web site: Coronavirus: Don't use vodka to sanitise hands . BBC News . 6 March 2020.
  27. Book: Eger II EI, Saidman LJ, Westhorpe RN . The Wondrous Story of Anesthesia. 14 September 2013. Springer Science & Business Media. 978-1-4614-8441-7 . 4– . live. https://web.archive.org/web/20170918190140/https://books.google.com/books?id=H--3BAAAQBAJ&pg=PA4. 18 September 2017.
  28. Shah . JB . The history of wound care. . The Journal of the American College of Certified Wound Specialists . September 2011 . 3 . 3 . 65–6 . 10.1016/j.jcws.2012.04.002 . 24525756. 3601883 .
  29. A Brief History of Wound Care . 10.1097/01.prs.0000225429.76355.dd . 2006 . Plastic and Reconstructive Surgery . 117 . 6S–11S . 16799371 . Broughton G, Janis JE, Attinger CE .
  30. Book: Block SS . Disinfection, Sterilization, and Preservation. 2001. Lippincott Williams & Wilkins . 9780683307405 . 14 . en . live. https://web.archive.org/web/20170113110342/https://books.google.ca/books?id=3f-kPJ17_TYC&pg=PA14. 13 January 2017.
  31. Grattan, N. "Treatment of Uterine Haemorrhage". Provincial Medicine and Surgical Journal. Vol. 1, No. 6 (Nov. 7, 1840), p. 107.
  32. Hirsh HL, Orsinger WH . Methylparafynol—a new type hypnotic. Preliminary report on its therapeutic efficacy and toxicity . American Practitioner and Digest of Treatment . 3 . 1 . 23–6 . January 1952 . 14903452 .
  33. Schaffarzick RW, Brown BJ . The anticonvulsant activity and toxicity of methylparafynol (dormison) and some other alcohols . Science . 116 . 3024 . 663–5 . December 1952 . 13028241 . 10.1126/science.116.3024.663 . 1952Sci...116..663S .
  34. Herz A . [A new type of hypnotic; unsaturated tertiary carbinols; experimental studies on therapeutic use of 3-methyl-pentin-ol-3 (methylparafynol)] . Arzneimittel-Forschung . 4 . 3 . 198–9 . March 1954 . 13159700 .
  35. Book: Hines, Richard Devenport . The Pursuit of Oblivion . 2002 . 327 .

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