Drug reference

ethanol

Antidote, Analgesic, Vasodilator

CDSCO approved

EXCRETION

—

not curated

INTERACTIONS

12 major

SEVERE in our sources

PREGNANCY

FDA category + note

Top interactionssee all 12 →

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Mechanism

As a competitive inhibitor of alcohol dehydrogenase, ethanol slows the metabolism of methanol and ethylene glycol to their toxic metabolites. For pain relief, it destroys sympathetic ganglia, causing vasodilation and analgesia.

Indications

poisoning by methanol or ethylene glycol (to competitively inhibit alcohol dehydrogenase)relief of long-lasting pain related to trigeminal neuralgia, inoperable carcinoma, and other conditions (via injection near nerves or sympathetic ganglia)promote healing of lesions in patients with vascular disease of the lower extremities (via lumbar paravertebral injections to destroy sympathetic ganglia and cause vasodilation)External antisepticAntidote to ethylene glycol and methanolrelief from chronic pain associated with a blind and painful eyeAntisepticrubefacientcounterirritant for sprains and joint painsprevention of bedsoresastringent in antiperspirant and aftershave lotionsalcoholic sponges to reduce body temperature in feverinjection around nerve for intractable neuralgias and severe cancer painappetite stimulantcarminativereflex stimulation in fainting/hysteriatreatment of methanol poisoningantiseptic and cleansing agentbefore hypodermic injectionminor cuts

Dosing

Adult: A 12-oz bottle of beer (355 mL), a 5-oz glass of wine (148 mL), and a 1.5-oz “shot” of 40% liquor (44 mL) each contain about 14 g ethanol and constitute what is defined as a “standard drink” in the U.S. Ingestion of low to moderate amounts for anxiolytic actions.
Pediatric: Ingestion in pregnancy is contraindicated due to teratogenic effects.

Pharmacokinetics

Bioavailability

Rapidly absorbed from the stomach and small intestine; peak blood levels occur about 30 min after ingestion on an empty stomach. First-pass metabolism by gastric and liver ADH.

Protein binding

Distributes into total body water (~0.65 L/kg body weight).

Metabolism

Primarily by sequential hepatic oxidation: first to acetaldehyde by ADH, then to acetic acid by ALDH. Also metabolized by catalase and CYP2E1 (approximately 10%), with possible participation of CYPs 1A2 and 3A4. Metabolism proceeds via zero-order kinetics at BECs greater than 10 mg% and by first-order kinetics at BECs less than 10 mg%.…

Excretion

Small amounts excreted in urine, sweat, and breath.

Contraindications

pregnancy (no known safe amount, current recommendations are to drink no alcohol during pregnancy)
concomitant use with fomepizole
Combined with benzodiazepines
Chronic use in pregnancy
Peptic ulcer
hyperacidity
gastroesophageal reflux
epileptics
severe liver disease
unstable personalities
pregnant women
mucous membranes
delicate skin (e.g., scrotum)
ulcers
disinfecting instruments (does not kill spores, promotes rusting)

Side effects

Common

cutaneous vasodilationCNS depressiondiuresisdecreased sexual performanceinitial stimulatory effectgiddinessmuscle relaxationimpaired judgmentslurred speechincoordinationunsteady gaitimpaired attentionmood labilitycognitive deficitsaggressivenessanterograde amnesia (alcoholic blackout)nystagmussedationheadache (hangover)thirst (hangover)nausea (hangover)hyperexcitability (hangover)insomniaSleepinessMotor incoordinationStimulation (initial effects, particularly at lower doses)Nauseavomitingflushinghangovertraffic accidentscutaneous and gastric vasodilatationtachycardiamild rise in BPmild anaemiaaltered bowel movementsimpotencetesticular atrophygynaecomastiainfertilityburning sensation (on open wounds)injures the surface (on open wounds)forms a coagulum under which bacteria could grow (on open wounds)

Serious

respiratory depression
coma
death
Wernicke-Korsakoff syndrome
alcoholic dementia
hypothermia
acute respiratory distress syndrome (ARDS)
anemias (macrocytic, sideroblastic)
thrombocytopenia
leukopenia
liver diseases (steatosis, steatohepatitis, fibrosis, cirrhosis)
gastritis
pancreatitis
Mallory-Weiss syndrome
oral cavity cancer
pharynx cancer
larynx cancer
colorectal cancer
esophageal squamous cell carcinoma
liver cancer
breast cancer
fetal alcohol spectrum disorders (FAS, ARND, ARBD)
cardiac arrhythmias (atrial fibrillation)
alcoholic cardiomyopathy
hypertension
stroke
Death (at high blood alcohol levels)
Liver disease
Cardiovascular disease
Endocrine effects
Gastrointestinal effects
Malnutrition
CNS dysfunctions
Fetal alcohol syndrome (in offspring of pregnant users)
Depressive symptoms (during intoxication)
Anxiety syndromes (during acute withdrawal)
damage to other nerve fibers (paralysis of extraocular muscles, neuroparalytic keratitis)
low IQ baby (teratogenic)
growth retardation (teratogenic)
foetal alcohol syndrome (teratogenic)
CNS depression (mental clouding, disorganization of thought, impairment of attention, memory, gait, perception, drowsiness, stupor, unconsciousness)
medullary paralysis
precipitation of seizures in epileptics
shrinkage of brain
chronic hypertension
cardiomyopathy
atrial fibrillation
other cardiac arrhythmias
megaloblastic anaemia (due to interference with folate metabolism)
acute pancreatitis
alcoholic cirrhosis
oxidative stress and cellular necrosis in liver
weakness and myopathy
hypoglycaemia
foetal alcohol syndrome
intrauterine and postnatal growth retardation
low IQ
microcephaly
cranio-facial and other abnormalities
immunological impairment
miscarriage
stillbirths
low birth-weight babies
polyneuritis
pellagra
tremors
seizures
loss of brain mass
wernicke’s encephalopathy
korsakoff’s psychosis
congestive heart failure
oropharyngeal malignancy
esophageal malignancy
hepatic malignancy
respiratory infections
depressed immune function