Water for injection

Water for injection is water of extra high quality without significant contamination.[1] A sterile version is used for making solutions that will be given by injection.[2] Before such use other substances generally must be added to make the solution isotonic.[3] Isotonic solutions containing water for injection can be given by injection into a vein, muscle, or under the skin.[4] A non-sterile version may be used in manufacturing with sterilization occurring later in the production process.[5]

Water for injection
Sterile water for injection
Clinical data
AHFS/Drugs.comFDA Professional Drug Information
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FormulaH2O

Side effects and mechanisms

The primary use of sterile water for injection is as an ingredient for dilution of other medications (aseptic preparation of parenteral solutions).[6] If it is given by injection into a vein without making it approximately isotonic, breakdown of red blood cells may occur.[3] This can then result in kidney problems.[3] Excessive amount may also result in fluid overload.[4] Water for injection is generally made by distillation or reverse osmosis.[5] It should contain less than a mg of elements other than water per 100 ml.[5] Versions with agents that stop bacterial growth are also available.[5]

In the UK, some hospitals offer subcutaneous injections of water directly for treating back pain in labour. It is controversial, with some claiming it is pseudoscience.[7] Because sterile water is not isotonic, its injection causes acute pain.[8] One purported mechanism of action is to induce acute local pain to compete directly with diffuse back pain through a mechanism called diffuse noxious inhibitory control; another hypothesis is instead that the acute pain releases endorphins.[8] A review and meta-analysis in 2009 found the benefits of its use inconclusive.[8]

History and culture

It is on the World Health Organization's List of Essential Medicines.[9][10] Water for injection is available over the counter in the United States.[3]

Other names

Water for injection is also known as aqua ad iniectabilia or aqua ad injectionem.

References
  1. "<1231> Water for Pharmaceutical Purposes" (PDF). hmc.usp.org. p. 2. Archived from the original (PDF) on 11 March 2015. Retrieved 14 January 2017.
  2. World Health Organization (2009). Stuart MC, Kouimtzi M, Hill SR (eds.). WHO Model Formulary 2008. World Health Organization. p. 493. hdl:10665/44053. ISBN 9789241547659.
  3. "Sterile Water for Injection - FDA prescribing information, side effects and uses". Drugs.com. Archived from the original on 18 January 2017. Retrieved 14 January 2017.
  4. "Water for Injection - FDA prescribing information, side effects and uses". Drugs.com. Archived from the original on 16 July 2017. Retrieved 14 January 2017.
  5. Ghosh, Tapash K.; Jasti, Bhaskara R. (2004). Theory and Practice of Contemporary Pharmaceutics. CRC Press. p. 396. ISBN 9780203644478. Archived from the original on 16 January 2017.
  6. https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/018632s051lbl.pdf
  7. Shaun Lintern (27 November 2022). "Water jabs and burning herbs offered during natural births at NHS hospitals". The Times. ISSN 0140-0460. Retrieved 30 September 2023.
  8. Hutton, E. K.; Kasperink, M.; Rutten, M.; Reitsma, A.; Wainman, B. (August 2009). "Sterile water injection for labour pain: a systematic review and meta-analysis of randomised controlled trials". BJOG: An International Journal of Obstetrics and Gynaecology. 116 (9): 1158–1166. doi:10.1111/j.1471-0528.2009.02221.x. ISSN 1471-0528. PMID 19459860. S2CID 19914146.
  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. World Health Organization (2021). World Health Organization model list of essential medicines: 22nd list (2021). Geneva: World Health Organization. hdl:10665/345533. WHO/MHP/HPS/EML/2021.02.
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