Alcohols (medicine)

Alcohols, in various forms, are used within medicine 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 be used both to disinfect the skin of the person and as hand sanitizer of the healthcare providers.[2] They can also be used 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]

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

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]

Alcohol has been used as an antiseptic as early as 1363, with evidence to support its use becoming available in the late 1800s.[8] It is on the World Health Organization's List of Essential Medicines.[9] Commercial formulations of hand sanitizer or with other agents such as chlorhexidine are available.[7][10]

Medical uses

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

Taken by mouth or injected into a vein ethanol is used to treat methanol or ethylene glycol toxicity when fomepizole is not available.[1]

Additionally, 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."[11]

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.[12]

History

Alcohol has been used as an antiseptic as early as 1363 with evidence to support its use becoming available in the late 1800s.[8] Since antiquity, prior to the development of modern agents, alcohol was used as a general anesthetic.[13]

Society and culture

Economics

As Ablysinol, its pricing is expensive; it's just strong alcohol, but if purchased as a medication for internal use, it went from $1,300 to $10K per 10-pack in 2020, due to FDA administrator action granting exclusivity when used for treating hypertrophic obstructive cardiomyopathy in the US through 2025, despite "misuse" of the orphan drug act.[14][15][16]

References
  1. British National Formulary: BNF 69 (69th ed.). British Medical Association. 2015. pp. 42, 838. ISBN 9780857111562.
  2. 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. 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. "WHO Model List of Essential Medicines (19th List)" (PDF). World Health Organization. April 2015. Archived (PDF) from the original on 13 December 2016. Retrieved 8 December 2016.
  7. 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. Block SS (2001). Disinfection, Sterilization, and Preservation. Lippincott Williams & Wilkins. p. 14. ISBN 9780683307405. Archived from the original on 13 January 2017.
  9. World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
  10. Bolon MK (September 2016). "Hand Hygiene: An Update". Infectious Disease Clinics of North America. 30 (3): 591–607. doi:10.1016/j.idc.2016.04.007. PMID 27515139.
  11. 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. Oxford University Press. 2021 (8): rjab224. doi:10.1093/jscr/rjab224. PMC 8384448. PMID 34447570.
  12. Barceloux DG, Bond GR, Krenzelok EP, Cooper H, Vale JA (2002). "American Academy of Clinical Toxicology practice guidelines on the treatment of methanol poisoning". Journal of Toxicology. Clinical Toxicology. 40 (4): 415–446. doi:10.1081/CLT-120006745. PMID 12216995. S2CID 26495651.
  13. 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.
  14. Paavola A (12 February 2020). "Why price of dehydrated alcohol is going from $1,300 to $10K". www.beckershospitalreview.com.
  15. "Biotech executives, having pledged fair pricing, criticize drugmaker for steep hike". BioPharma Dive.
  16. "Statement on Belcher Pharmaceuticals". linkedin. Retrieved 19 October 2023.
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