Alcohol absolute parenteral
- Drugs List
- Therapeutic Indications
- Dosage
- Administration
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Solution for injection containing ethanol
Drugs List
Therapeutic Indications
Uses
Treatment of acute poisoning by ethylene glycol or methyl alcohol
Trigeminal neuralgia
Dosage
Adults
Treatment of methanol poisoning
A loading dose of 600 to 800 mg/kg should be given over 30 minutes preferably via a central venous catheter. The absolute alcohol injection should be diluted with 5% glucose solution for infusion to give either a 5% or 10% solution of ethanol.
The loading dose should take the form of 7.5 ml/kg of the 10% solution or 15 ml/kg of the 5% solution.
Blood monitoring should occur every 1 to 2 hours until a concentration of 1 to 1.5 g/litre is reached, thereafter the blood concentration should be measured every 2 to 4 hours.
The standard maintenance dose is dependant on the patients drinking habits.
A non-drinker should receive 80 to 83 mg/kg/hour as either 0.83 ml/kg/hour of the 10% solution or 1.66 ml/kg/hour of the 5% solution.
An average adult should receive 120 to 138 mg/kg/hour as either 1.38 ml/kg/hour of the 10% solution or 2.76 ml/kg/hour of the 5% solution.
A drinker should receive 184 to 196 mg/kg/hour as either 1.96 ml/kg/hour of the 10% solution or 3.92 ml/kg/hour of the 5% solution.
Maintenance dose during dialysis is dependant on the patients drinking habits.
A non-drinker should receive 200 to 213 mg/kg/hour as either 2.13 ml/kg/hour of the 10% solution or 4.26 ml/kg/hour of the 5% solution.
An average adult should receive 240 to 268 mg/kg/hour as either 2.68 ml/kg/hour of the 10% solution or 5.36 ml/kg/hour of the 5% solution.
A drinker should receive 308 to 326 mg/kg/hour as either 3.26 ml/kg/hour of the 10% solution or 6.52 ml/kg/hour of the 5% solution.
Alcohol absolute can be added to peritoneal dialysate at a concentration of 1 to 2 g/litre of dialysate.
Severe and chronic pain including trigeminal neuralgia
Alcohol absolute should be injected into or near the individual nerve root or ganglion. The needle tip should ideally be located by radiographic or fluoroscopic means prior to dose delivery. A 0.2 ml injection should be used for a small nerve root up to 10 ml for blockade of the coeliac ganglion.
Elderly
(See Dosage; Adult)
Children
Treatment of methanol poisoning
A loading dose of 600 to 800 mg/kg should be given over 30 minutes preferably via a central venous catheter. The absolute alcohol injection should be diluted with 5% glucose solution for infusion to give either a 5% or 10% solution of ethanol.
The loading dose should take the form of 7.5 ml/kg of the 10% solution or 15 ml/kg of the 5% solution.
Blood monitoring should occur every 1 to 2 hours until a concentration of 1 to 1.5 g/litre is reached, thereafter the blood concentration only needs to be measured every 2 to 4 hours.
The standard maintenance dose is 80 to 83 mg/kg/hour as either 0.83 ml/kg/hour of the 10% solution or 1.66 ml/kg/hour of the 5% solution.
Maintenance dose during dialysis is 200 to 213 mg/kg/hour as either 2.13 ml/kg/hour of the 10% solution or 4.26 ml/kg/hour of the 5% solution.
Alcohol absolute can be added to peritoneal dialysate at a concentration of 1 to 2 g/litre of dialysate.
Severe and chronic pain including trigeminal neuralgia
Alcohol absolute should be injected into or near the individual nerve root or ganglion. The needle tip should ideally be located by radiographic or fluoroscopic means prior to dose delivery. A 0.2 ml injection should be used for a small nerve root up to 10 ml for blockade of the coeliac ganglion.
Patients with Renal Impairment
No dose adjustment is necessary although the doses below are advised for patients on dialysis or peritoneal dialysis.
Maintenance dose during dialysis is dependant on the patients drinking habits.
A non-drinker or child should receive 200 to 213 mg/kg/hour as either 2.13 ml/kg/hour of the 10% solution or 4.26 ml/kg/hour of the 5% solution.
An average adult should receive 240 to 268 mg/kg/hour as either 2.68 ml/kg/hour of the 10% solution or 5.36 ml/kg/hour of the 5% solution.
A drinker should receive 308 to 326 mg/kg/hour as either 3.26 ml/kg/hour of the 10% solution or 6.52 ml/kg/hour of the 5% solution.
Alcohol absolute can be added to peritoneal dialysate at a concentration of 1 to 2 g/litre of dialysate.
Administration
For intravenous or perineural administration.
Therapeutic Drug Monitoring
Treatment of methanol poisoning
Blood monitoring should occur every 1 to 2 hours until a concentration of 1 to 1.5 g/litre is reached, thereafter the blood concentration only needs to be measured every 2 to 4 hours.
The infusion rate should be adjusted to maintain a blood concentration of 1 to 1.5 g/litre after the loading dose.
Contraindications
None known
Precautions and Warnings
Breastfeeding
Hepatic impairment
Peptic ulcer
Porphyria
Pregnancy
Advise patient not to drive or operate machinery until assessed
Monitor for signs of neurological toxicity
Monitor plasma concentrations of this drug
Monitor respiratory function
Pregnancy and Lactation
Pregnancy
Use alcohol injection with caution in pregnancy.
The oral use of alcohol during pregnancy is linked for foetal alcohol syndrome. The volume of alcohol used in a nerve black is unlikely to affect the foetus. The risk to the foetus from significant methanol or ethylene glycol poisoning exceeds that of appropriate treatment.
The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Lactation
Use alcohol injection with caution in breastfeeding.
Alcohol passes into human breast milk in similar concentrations to the maternal plasma level. The alcohol does not remain in the milk and is cleared relatively quickly, so it is suggested that the patient does not breastfeed during treatment and until blood alcohol levels have fallen.
Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1
Side Effects
Amnesia
Ataxia
Cardiomyopathy
Cardiovascular collapse
Coma
Dizziness
Dysarthria
Emotional lability
Headache
Hypertension
Hypoglycaemia
Hypotension
Hypothermia
Impairment of judgement
Inco-ordination
Lethargy
Nausea
Nystagmus
Respiratory depression
Slurred speech
Stupor
Tremor
Visual disturbances
Vomiting
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Further Information
Last Full Review Date: April 2015
Reference Sources
Martindale: The Complete Drug Reference (online) London: Brayfield A (ed). Pharmaceutical Press Accessed on 17 April 2015.
Summary of Product Characteristics: Dehydrated Alcohol (Absolute Alcohol) BP for Injection. Martindale Pharmaceuticals Ltd. Revised March 2008.
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