DEHYDRATED ALCOHOL
Clinical safety rating
cautionComprehensive clinical and safety monograph for DEHYDRATED ALCOHOL (DEHYDRATED ALCOHOL).
Dehydrated alcohol (ethanol) causes tissue necrosis by protein denaturation and cellular dehydration, leading to vascular thrombosis and ischemic infarction. It ablates nerve tissue by extracting lipids and precipitating proteins.
| Metabolism | Primarily hepatic via alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH); minor metabolism via CYP2E1 at high concentrations. |
| Excretion | Ethanol is primarily eliminated by hepatic metabolism (90-98%) via alcohol dehydrogenase and aldehyde dehydrogenase, with 2-10% excreted unchanged in urine, breath, and sweat. Renal elimination is minor and variable. |
| Half-life | 2-4 hours in most individuals at zero-order kinetics; terminal half-life is concentration-dependent due to saturation of alcohol dehydrogenase. Clinically, elimination rate is constant at 15-20 mg/dL/hour in non-tolerant individuals. |
| Protein binding | Negligible (<5%); no specific binding proteins. |
| Volume of Distribution | 0.5-0.7 L/kg, approximating total body water. Higher in females due to lower lean body mass. |
| Bioavailability | Oral: ~80-100% due to rapid absorption from stomach and small intestine; IV: 100%. |
| Onset of Action | Oral: 5-10 minutes for mild CNS effects; IV: immediate (within seconds to minutes) due to direct vascular access. |
| Duration of Action | Oral: 1-3 hours depending on dose and tolerance; IV: shorter due to rapid redistribution. Clinical effects (CNS depression) last until blood levels fall below 50-100 mg/dL. |
| Molecular Weight | 46.07 |
Intravenous administration: 0.1-1 mL of sterile dehydrated alcohol (100% ethanol) injected directly into cystic lesions or tumors under imaging guidance. Maximum volume per injection: 1 mL, repeated up to 3 times per session depending on lesion size.
| Dosage form | SOLUTION |
| Renal impairment | No dosage adjustment required for renal impairment. |
| Liver impairment | No specific Child-Pugh-based adjustments; use with caution in severe hepatic dysfunction due to potential accumulation. |
| Pediatric use | Not recommended for use in pediatric patients due to lack of safety and efficacy data. |
| Geriatric use | No specific dose adjustment; use with caution due to age-related comorbidities and potential for increased sensitivity. |
| 1st trimester | Contraindicated due to teratogenicity; avoid use. |
| 2nd trimester | Contraindicated; use only if essential for maternal survival. |
| 3rd trimester | Contraindicated; use only if essential for maternal survival. |
Clinical note
Comprehensive clinical and safety monograph for DEHYDRATED ALCOHOL (DEHYDRATED ALCOHOL).
| Placental transfer | Complete; rapidly crosses placenta, reaching equilibrium with maternal blood. |
| Breastfeeding | Alcohol is excreted into breast milk; peaks at 30-60 minutes after ingestion. Chronic use may impair infant development; acute use should be limited and breastfeeding avoided for 2 hours per drink. |
| Lactation Rating | L3 - Moderately Safe (avoid high doses or chronic use) |
| Teratogenic Risk | First trimester: Data limited; alcohol is a known teratogen causing fetal alcohol spectrum disorders. Increased risk of congenital anomalies (e.g., heart defects, microcephaly) with high systemic exposure. Second trimester: Continued risk for growth restriction and neurodevelopmental abnormalities. Third trimester: Risk of growth retardation, preterm birth, and neurobehavioral deficits. Avoid systemic use; local injection for nerve block or ablation has minimal systemic absorption but caution advised. |
| Fetal Monitoring | Monitor for signs of alcohol intoxication (sedation, hypoglycemia). In pregnancy, fetal ultrasound for growth and anatomy if systemic exposure occurs. Monitor maternal blood glucose levels due to risk of hypoglycemia. Observe for local injection site complications (hematoma, infection). |
| Fertility Effects | Chronic alcohol use can impair fertility in both sexes (e.g., menstrual irregularities, reduced sperm count). No direct fertility impairment with therapeutic single-dose injection. |
■ FDA Black Box Warning
No FDA boxed warning exists for dehydrated alcohol. However, it should only be administered by physicians experienced in injection techniques for specific indications due to risk of tissue necrosis and nerve damage.
| Serious Effects |
Known hypersensitivity to ethanolSevere hepatic impairmentConcurrent use of disulfiram or metronidazoleAlcoholism or chronic alcohol abuse
| Precautions | Risk of tissue necrosis and sloughing if extravasation occurs, Neurological injury if injected near nerves (e.g., peripheral nerve damage, paralysis), Hypotension and bradycardia during celiac plexus block, Alcohol intoxication and CNS depression if absorbed systemically, Use with caution in patients with liver disease or diabetes mellitus |
| Food/Dietary | No specific food interactions. However, avoid alcohol consumption for 24 hours post-procedure due to risk of additive CNS depression. |
| Clinical Pearls | Absolute ethanol (dehydrated alcohol) is used for neurolysis in celiac plexus block for pancreatic cancer pain and for ablation of certain soft tissue lesions. Administer slowly to avoid local toxicity. Inadvertent intravascular injection can cause immediate pain and tissue necrosis. Use ultrasound or CT guidance for accurate placement. Monitor for hypotension, pain, and transient alcohol intoxication. Contraindicated in patients with bleeding disorders or local infection. |
| Patient Advice | You may feel a temporary burning sensation at the injection site. · This medication is used to block pain signals from certain nerves. · Avoid alcohol consumption for 24 hours after the procedure to prevent additive effects. · Report any severe pain, bleeding, or signs of infection to your healthcare provider. · You may experience temporary dizziness or lightheadedness after the injection. |
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