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Alcohols (medicine)

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This article is about use of alcohols in medicine. For ethanol as a psychoactive drug, see Alcohol (drug). For other uses, see Ethanol.

Alcohol
Skeletal formula of ethanol
Ethanol is a commonly used medical alcohol.
Clinical data
Routes of
administration		Topical, intravenous, by mouth
Drug classAntiseptics, disinfectants, antidotes
ATC code
Legal status
Legal status
Pharmacokinetic data
MetabolismLiver
Identifiers
CAS Number
PubChem CID
DrugBank
ChemSpider
UNII

Alcohols, in various forms, are used medically as an antiseptic, disinfectant, and antidote.[1] Alcohols applied to the skin are used to disinfect skin before a needle stick and before surgery.[2] They may also be used as a hand sanitizer;[2] to clean other areas;[2] and in mouthwashes.[3][4][5] Taken by mouth or injected into a vein, ethanol is used to treat methanol or ethylene glycol toxicity when fomepizole is not available.[1]

Side effects of alcohols applied to the skin include skin irritation.[2] Care should be taken with electrocautery, as ethanol is flammable.[1] 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

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

Alcohol septal ablation

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Main article: Alcohol septal ablation

Ablysinol (a brand of 99% ethanol medical alcohol) was sold from $1,300 to $10,000 per 10-pack[Give volume amount please] 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][unreliable source?]

Antiseptics

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Alcohols

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Ethanol is listed under Antiseptics, and Alcohol based hand rub under Disinfectants, on the World Health Organization's List of Essential Medicines.[6]

Applied to the skin, alcohols are used to disinfect skin before a needle stick and before surgery.[2] They may be used both to disinfect the skin of the person and the hands of the healthcare providers.[2] They can also be used to clean other areas,[2] and in mouthwashes.[3]

Both ethanol and isopropyl alcohol are common ingredients in topical antiseptics, including hand sanitizer.[11]

Risks
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Research indicates that alcohol used as pre-surgical antiseptic preparations for ear procedures may have some ototoxic properties.[12] In this regard, these alcohol preparations may be considered potential ototoxic medication.

Antidote

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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.[1]

Mechanism

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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

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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.[16]

Medicinal solvent

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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[17] and may need to be avoided in individuals with adverse reactions to ethanol such as alcohol-induced respiratory reactions.[18] 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.[19]

Some medicinal solutions of ethanol are also known as tinctures.

Mouthwash

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Usually mouthwashes are antiseptic solutions intended to reduce the microbial load in the mouth, although other mouthwashes might be given for other reasons such as for their analgesic, anti-inflammatory or anti-fungal action. Also, alcohol is added to mouthwash not to destroy bacteria but to act as a carrier agent for essential active ingredients such as menthol, eucalyptol and thymol, which help to penetrate plaque.[20]

A 2020 systematic review and meta-analysis concluded that there is no definitive link between alcohol-based mouthwash use and the risk of oral cancer.[21] This should not be confused with the fact that alcohol consumption at any quantity is a risk factor for alcohol and cancer such as cancers of the mouth, esophagus, pharynx and larynx.[22]

Sclerosant

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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."[23]

Sedative

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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.[24] 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

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Unproven methods against COVID-19

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Unproven COVID-19 prevention from alcohol consumption

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Drinking alcohol will not prevent or cure COVID-19,[25] contrary to some claims.[26]

Unproven COVID-19 hand sanitizer

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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.[27][28][medical citation needed]

History

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See also: Medicinal Liquor Prescriptions Act of 1933

Ancient world

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Since antiquity, prior to the development of modern agents, alcohol was used as a general anesthetic.[29]

Detail from The Good Samaritan by Cornelis van Haarlem (1627) showing the Samaritan pouring oil and wine on the injured man's wounds

In the history of wound care, beer,[30] and wine,[31] are recognized as substances used for healing wounds.

Late Middle Ages

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Alcohol has been used as an antiseptic as early as 1363, with evidence to support its use becoming available in the late 1800s.[32]

At times and places of poor public sanitation (such as medieval Europe), the consumption of alcoholic drinks was a way of avoiding water-borne diseases such as cholera.[33]

Modern period

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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.[34] 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.[35][36][37] The drug has been replaced by benzodiazepines and is no longer sold anywhere.[38]

References

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  1. ^ a b c d British National Formulary: BNF 69 (69th ed.). British Medical Association. 2015. pp. 42, 838. ISBN 9780857111562.
  2. ^ a b c d e f g World Health Organization (2009). Stuart MC, Kouimtzi M, Hill SR (eds.). WHO Model Formulary 2008. World Health Organization. p. 321. hdl:10665/44053. ISBN 9789241547659.
  3. ^ a b Limeback H (11 April 2012). Comprehensive Preventive Dentistry. John Wiley & Sons. pp. 138–. ISBN 978-1-118-28020-1. Archived from the original on 18 September 2017.
  4. ^ Kuriakose MA (8 December 2016). Contemporary Oral Oncology: Biology, Epidemiology, Etiology, and Prevention. Springer. pp. 47–54. ISBN 978-3-319-14911-0. Archived from the original on 18 September 2017.
  5. ^ Jameel RA, Khan SS, Kamaruddin MF, Abd Rahim ZH, Bakri MM, Abdul Razak FB (October 2014). "Is synthetic mouthwash the final choice to treat oral malodour?". Journal of the College of Physicians and Surgeons--Pakistan. 24 (10): 757–762. PMID 25327922.
  6. ^ a b World Health Organization (2023). The selection and use of essential medicines 2023: web annex A: World Health Organization model list of essential medicines: 23rd list (2023). Geneva: World Health Organization. hdl:10665/371090. WHO/MHP/HPS/EML/2023.02.
  7. ^ a b c McDonnell G, Russell AD (January 1999). "Antiseptics and disinfectants: activity, action, and resistance". Clinical Microbiology Reviews. 12 (1): 147–179. doi:10.1128/cmr.12.1.147. PMC 88911. PMID 9880479.
  8. ^ Paavola A (12 February 2020). "Why price of dehydrated alcohol is going from $1,300 to $10K". www.beckershospitalreview.com.
  9. ^ "Biotech executives, having pledged fair pricing, criticize drugmaker for steep hike". BioPharma Dive.
  10. ^ "Statement on Belcher Pharmaceuticals". linkedin. Retrieved 19 October 2023.
  11. ^ "Q&A for Consumers | Hand Sanitizers and COVID-19". Center for Drug Evaluation and Research (CDER). U.S. Food and Drug Administration. 12 May 2023.
  12. ^ Singh S, Blakley B (March 2018). "Systematic review of ototoxic pre-surgical antiseptic preparations - what is the evidence?". Journal of Otolaryngology - Head & Neck Surgery = le Journal d'Oto-Rhino-Laryngologie et de Chirurgie Cervico-Faciale. 47 (1): 18. doi:10.1186/s40463-018-0265-z. PMC 5831715. PMID 29490694.
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  21. ^ Aceves Argemí R, González Navarro B, Ochoa García-Seisdedos P, Estrugo Devesa A, López-López J (June 2020). "Mouthwash With Alcohol and Oral Carcinogenesis: Systematic Review and Meta-analysis". The Journal of Evidence-Based Dental Practice. 20 (2): 101407. doi:10.1016/j.jebdp.2020.101407. PMID 32473798.
  22. ^ Gormley M, Creaney G, Schache A, Ingarfield K, Conway DI (November 2022). "Reviewing the epidemiology of head and neck cancer: definitions, trends and risk factors". British Dental Journal. 233 (9): 780–786. doi:10.1038/s41415-022-5166-x. PMC 9652141. PMID 36369568.
  23. ^ Episalla NC, Orra S, Black CK, Dekker PK, Kim KG, Cardella JT, et al. (August 2021). "Sclerotherapy as an alternative treatment for complex, refractory seromas". Journal of Surgical Case Reports. 2021 (8). Oxford University Press: rjab224. doi:10.1093/jscr/rjab224. PMC 8384448. PMID 34447570.
  24. ^ Glauser FL, Smith WR, Caldwell A, Hoshiko M, Dolan GS, Baer H, et al. (January 1976). "Ethchlorvynol (Placidyl)-induced pulmonary edema". Annals of Internal Medicine. 84 (1): 46–48. doi:10.7326/0003-4819-84-1-46. PMID 942681.
  25. ^ "Myth busters". who.int. World Health Organization.
  26. ^ Baumgarten A. "10 common myths busted about coronavirus in North Dakota". The Dickinson Press. Retrieved 14 April 2020.
  27. ^ "Fact or Fiction: Tito's Vodka can be used in hand sanitizer?". KGTV. 10 March 2020. Retrieved 9 April 2020.
  28. ^ "Coronavirus: Don't use vodka to sanitise hands". BBC News. 6 March 2020.
  29. ^ Eger II EI, Saidman LJ, Westhorpe RN (14 September 2013). The Wondrous Story of Anesthesia. Springer Science & Business Media. pp. 4–. ISBN 978-1-4614-8441-7. Archived from the original on 18 September 2017.
  30. ^ Shah JB (September 2011). "The history of wound care". The Journal of the American College of Certified Wound Specialists. 3 (3): 65–66. doi:10.1016/j.jcws.2012.04.002. PMC 3601883. PMID 24525756.
  31. ^ John Gill's Exposition of the Bible Classic Bible Commentaries
  32. ^ Block SS (2001). Disinfection, Sterilization, and Preservation. Lippincott Williams & Wilkins. p. 14. ISBN 9780683307405. Archived from the original on 13 January 2017.
  33. ^ Dunn R. "Strong Medicine: Drinking Wine and Beer Can Help Save You from Cholera, Montezuma s Revenge, E. Coli and Ulcers 1". Scientific American Blog Network. Retrieved 27 June 2021.
  34. ^ Grattan, N. "Treatment of Uterine Haemorrhage". Provincial Medicine and Surgical Journal. Vol. 1, No. 6 (Nov. 7, 1840), p. 107.
  35. ^ Hirsh HL, Orsinger WH (January 1952). "Methylparafynol--a new type hypnotic. Preliminary report on its therapeutic efficacy and toxicity". American Practitioner and Digest of Treatment. 3 (1): 23–26. PMID 14903452.
  36. ^ Schaffarzick RW, Brown BJ (December 1952). "The anticonvulsant activity and toxicity of methylparafynol (dormison) and some other alcohols". Science. 116 (3024): 663–665. Bibcode:1952Sci...116..663S. doi:10.1126/science.116.3024.663. PMID 13028241.
  37. ^ Herz A (March 1954). "[A new type of hypnotic; unsaturated tertiary carbinols; experimental studies on therapeutic use of 3-methyl-pentin-ol-3 (methylparafynol)]". Arzneimittel-Forschung. 4 (3): 198–199. PMID 13159700.
  38. ^ Hines RD (2002). The Pursuit of Oblivion. p. 327.
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