Intravenous Antidote for methanol or ethylene glycol ingestion
Adult: As 100% dehydrated alcohol: Loading: 600-800 mg/kg given via infusion over 30 mins thru central venous catheter. Maintenance: 80-83 mg/kg/hr (non-drinker); 120-138 mg/kg/hr (average adult); 184-196 mg/kg/hr (drinker). As 10% ethanol: Loading: 7.5 mL/kg given via infusion over 30 min thru central venous catheter. Maintenance: 0.83 mL/kg/hr (non-drinker); 1.38 mL/kg/hr (average adult); 1.96 mL/kg/hr (drinker). Child: As 100% dehydrated alcohol: Loading: 600-800 mg/kg given via infusion over 30 mins thru central venous catheter. Maintenance: 80-83 mg/kg/hr. As 10% ethanol: Loading: 7.5 mL/kg given via infusion over 30 min thru central venous catheter. Maintenance: 0.83 mL/kg/hr.
Parenteral Chronic pain, Severe pain, Trigeminal neuralgia
Adult: As 100% dehydrated alcohol: 0.2 mL up to a max of 10 mL, given via inj into the nerve root or ganglion ideally located via radiographic or fluoroscopic imaging prior to admin.
Topical/Cutaneous Antiseptic and disinfectant
Adult: As 70% soln: Clean then apply a small amount on the affected area 1-3 times daily.
Renal Impairment
IV Antidote for methanol or ethylene glycol ingestion As 100% dehydrated alcohol: Loading: 600-800 mg/kg given via infusion over 30 mins thru central venous catheter. Maintenance during dialysis: 200-213 mg/kg/hr (non-drinker/child); 240-268 mg/kg/hr (average adult); 308-326 mg/kg/hr (drinker). As 10% ethanol: Loading: 7.5 mL/kg given via infusion over 30 mins thru central venous catheter. Maintenance during dialysis: 2.13 mL/kg/hr (non-drinker/child); 2.68 mL/kg/hr (average adult); 3.26 mL/kg/hr (drinker).
Contraindications
Seizure, diabetic coma. Concomitant use w/ opioid preparations.
Special Precautions
Patient w/ DM, gout, shock. Patient who underwent recent cranial surgery. Hepatic and renal impairment. Childn. Pregnancy and lactation.
This drug may cause dizziness, if affected, do not drive or operate machinery.
Monitoring Parameters
Monitor blood ethanol levels 1-2 hrly until steady state (100-150 mg/L) is reached, then 2-4 hrly thereafter. Monitor for signs and symptoms of CNS and resp depression. Monitor for methanol/ethylene glycol blood levels, blood glucose, arterial pH, blood gases, heart rate, and BP.
Overdosage
Symptoms: CNS depression. Management: Symptomatic and supportive treatment. Employ gastric lavage or aspiration for acute poisoning. Maintain fluid balance w/ suitable electrolyte solutions. Treat hypoglycaemia w/ glucose.
Drug Interactions
May cause unpleasant disulfiram-like reactions w/ chlorpropramide, metronidazole and some cephalosporins. May cause hypoglycaemia w/ sulphonylurea and insulin. May cause orthostatic hypotension w/ vasodilators (e.g. ACE inhibitors, adrenergic neuron blockers, β-blockers). Potentially Fatal: May enhance the effect of CNS depressants (e.g. hypnotics, sedatives, antihistamines, muscle relaxants, opioid analgesics, antiepileptics, antidepressants, antipsychotics).
Action
Description: Mechanism of Action: Alcohol is widely used as antiseptic and disinfectant due to its ability to denature proteins. It is bacteriostatic at low concentration and bactericidal at high concentration. As an antidote, it competitively inhibits alcohol dehydrogenase, an enzyme which catalyzes the metabolism of ethylene glycol and methanol into toxic metabolites. As a neurolytic, it causes protractive or even permanent anaesthesia by destroying nerves at inj site. Pharmacokinetics: Absorption: Rapidly absorbed from the GI tract. Rate of absorption is affected by food, concentration, carbonation, and the time of ingestion. Its vapour can be absorbed through the lungs. Distribution: Distributed throughout body fluids. Readily crosses the placenta and appears in breast milk, sweat, and other secretions. Volume of distribution: 0.6-0.7 L/kg. Metabolism: Metabolised in the liver by alcohol dehydrogenase into acetaldehyde and further oxidised into acetate via a microsomal oxidising system. Excretion: Via kidneys and lungs (approx 2% as unchanged).
Chemical Structure
Alcohol Source: National Center for Biotechnology Information. PubChem Database. Ethanol, CID=702, https://pubchem.ncbi.nlm.nih.gov/compound/Ethanol (accessed on Jan. 20, 2020)
Sign Out
