Ethanol (topical and injection): Pediatric drug information

For additional information see "Ethanol (topical and injection): Drug information" and "Ethanol (topical and injection): Patient drug information"

For abbreviations, symbols, and age group definitions show table

Brand Names: US

Ablysinol;
Epi-Clenz [OTC];
GelRite [OTC];
Lavacol [OTC];
Prevacare [OTC];
ProtecTeaV [OTC] [DSC];
Purell Advanced [OTC];
Purell [OTC]

Therapeutic Category

Anti-infective Agent, Topical;
Antidote, Ethylene Glycol Toxicity;
Antidote, Methanol Toxicity;
Fat Occlusion (Central Venous Catheter), Treatment Agent;
Neurolytic

Dosing: Pediatric

Antiseptic

Antiseptic: Children and Adolescents: Ethyl rubbing alcohol: Topical: Apply 1 to 3 times daily as needed.

Methanol or ethylene glycol ingestion

Methanol or ethylene glycol ingestion: Limited data available (Ref):

Infants, Children, and Adolescents: Note: IV administration is the preferred route; continue therapy until ethylene glycol and/or methanol is no longer detected or levels are <20 mg/dL and the patient is asymptomatic and metabolic acidosis has been corrected. If ethylene glycol and/or methanol levels are not available in a timely manner, continue therapy until the estimated time of clearance of ethylene glycol and/or methanol has elapsed and the patient is asymptomatic with a normal pH. If patient has coingested ethanol, measure the baseline serum ethanol concentration and adjust the ethyl alcohol loading dose based on results to achieve a serum ethanol level of ~100 mg/dL.

Absolute ethyl alcohol [98% (196 proof) = 77.4 g EtOH/dL]:

IV: Note: Consider consultation with a clinical toxicologist or poison control center for options related to compounding IV ethanol.

Initial: 600 to 700 mg/kg [equivalent to 7.6 to 8.9 mL/kg using a 10% solution].

Maintenance (not receiving hemodialysis): Goal of therapy is to maintain serum ethanol levels >100 mg/dL.

Patients who do not use alcohol regularly: 66 mg/kg/hour (equivalent to 0.83 mL/kg/hour using a 10% solution).

Patients who do use alcohol regularly: 154 mg/kg/hour (equivalent to 1.96 mL/kg/hour using a 10% solution).

Oral: Note: Solution must be diluted to a ≤20% concentration with water or juice and administered orally or via a nasogastric tube.

Initial: 600 to 700 mg/kg (equivalent to 0.78 to 0.9 mL/kg using a 98% solution).

Maintenance (not receiving hemodialysis): Goal of therapy is to maintain serum ethanol levels >100 mg/dL.

Patients who do not use alcohol regularly: 66 mg/kg/hour (equivalent to 0.09 mL/kg/hour using a 98% solution).

Patients who do use alcohol regularly: 154 mg/kg/hour (equivalent to 0.20 mL/kg/hour using a 98% solution).

Central venous catheter lock therapy for central line–associated bloodstream infection

Central venous catheter lock therapy for central line–associated bloodstream infection (CLABSI ): Limited data available; dosage regimen, dwell time, and concentration variable; refer to institution-specific protocols.

Prevention: Note: Conflicting data on efficacy; use recommended in patients with intestinal failure and long-term catheters; may also be considered in other populations at high risk of CLABSI (eg, patients with multiple prior episodes) (Ref).

Infants, Children, and Adolescents: Intracatheter: Instill a volume of 70% ethanol equal to the internal lumen volume of the catheter once daily; maximum volume: 3 mL; typically allow to dwell in lumen for 2 to 4 hours and then aspirate out of catheter; reported dwell time: 2 to 24 hours (Ref). Less frequent dosing (1 to 3 times weekly) has also been described (Ref).

Treatment:

Infants, Children, and Adolescents: Intracatheter: Instill a volume of 70% ethanol equal to the internal lumen volume of the catheter once daily; maximum volume: 3 mL; typically allow to dwell in lumen for 2 to 4 hours and then aspirate out of catheter; reported dwell time: 2 to 24 hours; treat for 5 to 7 days in combination with systemic antimicrobials (Ref). For fungal infections, longer duration of treatment (eg, 14 days after negative blood culture) has been described (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Methanol or ethylene glycol ingestion (Ref):

Infants, Children, and Adolescents: Absolute ethyl alcohol:

Dosage adjustment for hemodialysis: Maintenance dose:

IV:

Patients who do not use alcohol regularly: 169 mg/kg/hour (equivalent to 2.13 mL/kg/hour using a 10% solution).

Patients who do use alcohol regularly: 257 mg/kg/hour (equivalent to 3.26 mL/kg/hour using a 10% solution).

Oral:

Patients who do not use alcohol regularly: 169 mg/kg/hour (equivalent to 0.22 mL/kg/hour using a 98% solution).

Patients who do use alcohol regularly: 257 mg/kg/hour (equivalent to 0.33 mL/kg/hour using a 98% solution).

Dosing: Liver Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Adult

(For additional information see "Ethanol (topical and injection): Drug information")

Antiseptic

Antiseptic: Liquid denatured alcohol: Topical: Apply 1 to 3 times daily as needed.

Ethylene glycol or methanol toxicity

Ethylene glycol or methanol toxicity (alternative agent) (off-label use): Note: Promptly initiate in patients with confirmed toxic ingestion (ethylene glycol or methanol concentrations >20 mg/dL) or suspicion of ethylene glycol or methanol poisoning (eg, witnessed or compelling history of ingestion, elevated anion gap metabolic acidosis without clear alternative etiology, osmol gap >10 mOsm/kg) (Ref). The decision to initiate antidotal therapy often must be made before the receipt of confirmatory toxic alcohol concentration results. Consultation with a clinical toxicologist or poison center is highly recommended to determine the optimal patient-specific care, guidance related to compounding IV or oral ethanol solutions, and for oral dosing of commercial ethanol if pharmaceutical-grade ethanol is unavailable.

Loading dose:

**Ethanol Loading Dose for Methanol or Ethylene Glycol Toxicity**
Route	Ethanol concentration	Loading dose (mg/kg) ^a	Loading dose (mL/kg) ^a
^aAACT [Barceloux 1999]; AACT [Barceloux 2002]; Sivilotti 2024.
^b This loading dose is expected to raise the serum ethanol concentration by ~100 mg/dL (Sivilotti 2024). If the patient has coingested ethanol, measure the baseline serum ethanol concentration and adjust the ethyl alcohol loading dose based on results to achieve a serum ethanol level of ~100 mg/dL.
^c10% ethanol solution contains 79 mg ethanol/mL.
^d20% ethanol solution contains 158 mg ethanol/mL.
IV (preferred route)	10% solution^c	600 to 800 mg/kg^b	7.6 to 10 mL/kg^b
Oral	20% solution^d	600 to 800 mg/kg^b	3.8 to 5 mL/kg^b

Maintenance: Titrate ethanol dose based on frequent serum ethanol concentrations (eg, every 1 to 2 hours initially and following dose changes); less frequent monitoring (eg, every 2 to 4 hours) is appropriate once the dose is stable (Ref). Maintain a serum ethanol concentration of ~100 mg/dL (or at least one-quarter to one-third of the serum ethylene glycol or methanol concentration [mg/dL]) (Ref). Continue therapy until ethylene glycol or methanol have been reduced to ≤20 mg/dL and the patient is asymptomatic and with a normal pH (Ref).

**Ethanol Maintenance Dose for Methanol or Ethylene Glycol Toxicity**
Route	Ethanol concentration	Initial maintenance dose (mg/kg)^a	Initial maintenance dose (mL/kg)^a	Usual maintenance dose range (mg/kg)^a,c	Usual maintenance dose range (mL/kg)^a,c
^aAACT (Barceloux 1999); AACT (Barceloux 2002); Sivilotti 2024.
^bSolution must be administered orally or via a nasogastric tube. Due to its pharmacokinetics, ethanol must be administered precisely at 60-minute intervals (AACT [Barceloux 1999]; AACT [Barceloux 2002]).
^cHigh interpatient variability in ethanol clearance exists depending upon the physical status of the patient and their history of alcohol use; titrating above or below the stated doses may be necessary.
^d10% ethanol solution contains 79 mg ethanol/mL.
^e20% ethanol solution contains 158 mg ethanol/mL.
IV continuous infusion (preferred route)	10% solution^d	~80 mg/kg/hour	1 mL/kg/hour	66 to 154 mg/kg/hour	0.8 to 2 mL/kg/hour
Oral^b	20% solution^e	~80 mg/kg administered hourly	0.5 mL/kg administered hourly	66 to 154 mg/kg administered hourly	0.4 to 1 mL/kg administered hourly

Therapeutic nerve or ganglion block

Therapeutic nerve or ganglion block: Dehydrated alcohol injection 98%: Intraneural: Dosage variable depending upon the site of injection (eg, trigeminal neuralgia: 0.05 to 0.5 mL as a single injection per interspace vs subarachnoid injection: 0.5 to 1 mL as a single injection per interspace); single doses >1.5 mL are seldom required. Note: Administer when pain is from malignant origin only.

Replenishment of fluid and carbohydrate calories

Replenishment of fluid and carbohydrate calories: Dehydrated alcohol infusion: Alcohol 5% and dextrose 5%: 1 to 2 L/day by slow infusion.

Septal ablation for hypertrophic cardiomyopathy with left ventricular outflow tract obstruction

Septal ablation for hypertrophic cardiomyopathy with left ventricular outflow tract obstruction: Intracoronary: Dosage variable depending on septal anatomy and rate of contrast wash-out: Single dose: 1 to 3 mL of at least 95% concentration infused slowly into septal arterial branches; maximum dose: 5 mL/procedure. Note: Use the minimum dose necessary to achieve the desired reduction in peak left ventricular outflow tract pressure gradient; smaller amounts may reduce the size of the septal infarct and incidence of complications (eg, complete heart block) (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Ethylene glycol or methanol toxicity (off-label use): Note: Hemodialysis is considered an adjunct to ethanol in select patients (Ref); consultation with a clinical toxicologist or poison center is highly recommended to determine the optimal patient-specific care. The following dosing adjustments are for any patient receiving hemodialysis regardless of kidney function.

Hemodialysis (intermittent): Maintenance dose: In general, ethanol dose requirements are increased by ~50% during hemodialysis (Ref). Frequent serum ethanol concentrations (eg, every 1 to 2 hours initially and during and after hemodialysis) are required to determine the patient-specific clearance rate and appropriate maintenance dose (Ref).

Dosing: Liver Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

Frequency not defined.

Cardiovascular: Cardiac failure, heart block, myocardial necrosis (excessive), ventricular fibrillation, ventricular tachycardia

Central nervous system: Hyperesthesia, neuritis, pain, paresthesia

Contraindications

Hypersensitivity to ethyl alcohol or any component of the formulation; seizure disorder and diabetic coma; subarachnoid injection of dehydrated alcohol in patients receiving anticoagulants

Ablysinol: There are no contraindications listed in the manufacturer's labeling.

Warnings/Precautions

Concerns related to adverse effects:

• Heart block (septal ablation): Transient heart block is common at the time alcohol is injected into a septal artery; ~10% of complete heart block events become permanent and require a permanent pacemaker following percutaneous transluminal septal myocardial ablation. Risk factors for permanent pacemaker dependency include a baseline PQ interval >160 msec, baseline minimum heart rate <50 bpm, baseline left ventricular outflow gradient >70 mmHg, maximum QRS during the first 48 hours >155 msec, third-degree atrio-ventricular block occurring during the procedure, and no clinical recovery between 12 to 48 hours after the procedure.

• Myocardial infarction: Use is intended to create a controlled MI for therapeutic purposes. However, excessive myocardial necrosis and subsequent heart failure have been reported. Factors increasing the risk of excessive tissue necrosis include higher volume of alcohol used and a higher number of septal branches injected to reduce the left ventricular outflow tract gradient.

• Ventricular arrhythmia (septal ablation): Ventricular tachycardia and ventricular fibrillation requiring electrocardioversion occurred at a frequency of approximately 1%. Perform continuous electrocardiographic monitoring for 48 hours after the procedure.

Disease-related concerns:

• Diabetes: Use with caution in patients with diabetes mellitus; ethyl alcohol may decrease blood sugar.

• Gout: Use with caution in patients with gout.

• Hepatic impairment: Use with caution in patients with hepatic impairment.

• Shock: Use with caution in patients with shock.

Special populations:

• Cranial surgery: Use with caution in patients following cranial surgery.

• Older adult: Use with caution in the elderly; the rate of heart blocks, pacemaker dependency, and dysrhythmia following injection into a septal artery increased with age.

• Infants: Minimize dermal exposure of ethyl alcohol in infants as significant systemic absorption and toxicity can occur.

Other warnings/precautions:

• Administration: Parenteral: Proper positioning of the patient for neurolytic administration is essential to control localization of the injection of dehydrated alcohol (which is hypobaric) into the subarachnoid space; avoid extravasation. Not for SubQ administration. Do not administer simultaneously with blood due to the possibility of pseudoagglutination or hemolysis; may potentiate severe hypoprothrombic bleeding. Avoid extravasation during IV administration.

• Antiseptic: Appropriate use: Improper use may lead to product contamination. Although infrequent, product contamination has been associated with reports of localized and systemic infections. To reduce the risk of infection, ensure antiseptic products are used according to the labeled instructions; avoid diluting products after opening; and apply single-use containers only one time to one patient and discard any unused solution (FDA Drug Safety Communication 2013).

• Monitoring: Clinical evaluation and periodic lab determinations, including serum ethanol levels, are necessary to monitor effectiveness, changes in electrolyte concentrations, and acid-base balance (when used as an antidote). Monitor blood glucose closely, particularly in children as treatment of ingestions is associated with hypoglycemia.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Aerosol, foam, topical [instant hand sanitizer]:

Epi-Clenz: 62% (240 mL, 480 mL)

Foam, topical [instant hand sanitizer]:

Purell Advanced: 70% (45 mL, 535 mL, 700 mL, 1200 mL)

Gel, topical [instant hand sanitizer]:

Epi-Clenz: 70% (45 mL, 120 mL, 480 mL)

Epi-Clenz Plus: 62% (45 mL, 800 mL)

GelRite: 62% (120 mL, 480 mL, 800 mL, 1000 mL)

Prevacare: 60% (120 mL, 240 mL, 960 mL, 1200 mL, 1500 mL)

ProtecTeaV: 70% (236 mL [DSC])

Purell: 62% (15 mL, 30 mL, 59 mL, 60 mL, 120 mL, 236 mL, 240 mL, 250 mL, 360 mL, 500 mL, 800 mL, 1000 mL, 2000 mL)

Purell Advanced: 70% (30 mL, 236 mL, 1000 mL, 2000 mL)

Injection, solution [dehydrated, preservative free]:

Ablysinol: ≥99% (1 mL, 5 mL)

Generic: 98% (1 mL [DSC])

Liquid, topical [denatured]:

Lavacol: 70% (473 mL)

Generic: 70% (480 mL, 3840 mL)

Pad, topical [instant hand sanitizer/towelette]:

Purell: 62% (24s, 35s, 40s, 100s, 120s, 175s, 1000s, 4000s)

Generic Equivalent Available: US

Yes

Pricing: US

Gel (CareTouch Hand Sanitizer External)

75% (per mL): $0.08

Gel (Clever Choice Hand Sanitizer External)

70% (per mL): $0.10

Gel (HandClean Hand Sanitizer External)

70% (per mL): $0.02

Gel (Medi-First Antiseptic Cleaner External)

66.5% (per mL): $0.15

Gel (Prevacare Antimicrobial External)

60% (per mL): $0.03

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Administration: Pediatric

Oral: Ethylene glycol or methanol ingestion: After diluting ethyl alcohol to ≤20% solution, administer hourly by mouth or via nasogastric tube. Out-of-hospital management with orally administered ethanol is not recommended but has been demonstrated to be efficacious (Ref). Due to the pharmacokinetics of alcohol (ethyl), it is critical that oral ethanol be administered precisely at 60-minute intervals.

Parenteral: Not for SUBQ administration.

Intracatheter (venous access site): Central venous catheter lock: Instill diluted ethyl alcohol (≤70%) in a volume equal to the internal lumen volume of the catheter to ensure adequate lumen exposure and limit systemic exposure. Ethanol forms a visual precipitate with heparin or citrate; flush catheter well with normal saline before administration (Ref).

IV: Ethylene glycol or methanol ingestion: After diluting ethyl alcohol to 10% v/v solution, infuse initial dose IV over 60 minutes (Ref); central vein is the preferred route.

Administration: Adult

Oral: Ethylene glycol or methanol toxicity (off-label use): Using a 20% solution, administer hourly by mouth or via nasogastric tube. Out-of-hospital management with orally administered ethanol is not recommended but has been demonstrated to be efficacious when the situation warrants its use (eg, mass poisoning in a resource-limited setting; anticipated delay of medical care) (Ref). Due to the pharmacokinetics of alcohol (ethyl), it is critical that oral ethanol be administered precisely at 60-minute intervals.

IV: Ethylene glycol or methanol toxicity (off-label use): IV administration via a central vein is the preferred route. Administer as a 10% solution in D5W. Initial dose should be administered over 1 hour.

Treatment of occluded central venous catheter: Instill a 70% solution with a volume equal to the internal volume of the catheter. Assess patency at 30 to 60 minutes (or per institutional protocol).

Intraneural: Separate needles should be used for each of multiple injections or sites to prevent residual alcohol deposition at sites not intended for tissue destruction. Inject slowly after determining proper placement of needle. Since dehydrated alcohol is hypobaric when compared with spinal fluid, proper positioning of the patient is essential to control localization of injections into the subarachnoid space.

Intracoronary: Inject small volumes over 1 to 2 minutes percutaneously into septal arterial branches, guided by assessment of the gradient.

Storage/Stability

Store at room temperature. Do not refrigerate or freeze. Highly flammable; store away from any heat source and keep cool.

Pharmacy supply of emergency antidotes: Guidelines suggest that at least 180 to 360 g be stocked. Suggested amount is stated to be a sufficient quantity to treat 1 patient weighing 100 kg for an initial 8- to 24-hour period (Dart 2018); actual amount to be stocked should take into account site-specific and population-specific needs.

Use

Injection: Therapeutic neurolysis of nerves or ganglia for the relief of intractable, chronic pain in such conditions as inoperable cancer and trigeminal neuralgia (dehydrated alcohol injection) (FDA approved in adults); epidural or individual motor nerve injections to control certain manifestations of cerebral palsy and spastic paraplegia, celiac plexus block to relieve pain of inoperable upper abdominal cancer, and intra- and subcutaneously for relief of intractable pruritus ani (diluted [40% to 50%] dehydrated alcohol injection: FDA approved in adults); induction of controlled cardiac septal infarction to improve exercise capacity in patients with symptomatic hypertrophic cardiomyopathy who are not candidates for surgical myectomy (Ablysinol only: FDA approved in adults); has also been used as an antidote for the treatment of methanol and ethylene glycol ingestion and as a lock solution for the prevention and treatment of catheter-related infections.

Oral: Has been used as an antidote for the treatment of methanol and ethylene glycol ingestion.

Topical: Skin antiseptic (hand sanitizer gels, foams solutions and rubbing ethyl alcohol: FDA approved pediatric patients [age not specified] and adults).

Medication Safety Issues

Sound-alike/look-alike issues:

Ethanol may be confused with Ethyol, Ethamolin

Metabolism/Transport Effects

Induces CYP2E1 (Weak);

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program

Acetaminophen: Alcohol (Ethyl) may increase hepatotoxic effects of Acetaminophen. Risk C: Monitor

Acetohydroxamic Acid: Alcohol (Ethyl) may increase adverse/toxic effects of Acetohydroxamic Acid. Specifically, Alcohol (Ethyl) may increase the risk of Acetohydroxamic Acid associated rash. Risk C: Monitor

Acitretin: Alcohol (Ethyl) may increase teratogenic effects of Acitretin. Risk X: Avoid

Acrivastine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Agomelatine: Alcohol (Ethyl) may increase adverse/toxic effects of Agomelatine. Risk X: Avoid

Alizapride: Alcohol (Ethyl) may increase sedative effects of Alizapride. Risk X: Avoid

Alpha-Lipoic Acid: Alcohol (Ethyl) may decrease therapeutic effects of Alpha-Lipoic Acid. Risk X: Avoid

Amantadine: Alcohol (Ethyl) may increase CNS depressant effects of Amantadine. Alcohol may also cause dose-dumping for at least one extended-release amantadine product. Risk X: Avoid

Aminophylline: Alcohol (Ethyl) may increase serum concentration of Aminophylline. Risk C: Monitor

Amisulpride (Oral): May increase adverse/toxic effects of Alcohol (Ethyl). Risk X: Avoid

Amitriptylinoxide: Alcohol (Ethyl) may increase CNS depressant effects of Amitriptylinoxide. Risk X: Avoid

Apomorphine: Alcohol (Ethyl) may increase hypotensive effects of Apomorphine. Risk X: Avoid

Armodafinil: Alcohol (Ethyl) may decrease therapeutic effects of Armodafinil. Risk X: Avoid

Articaine: May increase CNS depressant effects of CNS Depressants. Management: Consider reducing the dose of articaine if possible when used in patients who are also receiving CNS depressants. Monitor for excessive CNS depressant effects with any combined use. Risk D: Consider Therapy Modification

Aspirin: Alcohol (Ethyl) may increase adverse/toxic effects of Aspirin. Specifically, alcohol may increase the bleeding risk of aspirin. Alcohol (Ethyl) may decrease therapeutic effects of Aspirin. Specifically, alcohol may interfere with the controlled release mechanism of extended release aspirin. Risk C: Monitor

Azelastine (Nasal): May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Azelastine (Systemic): Alcohol (Ethyl) may increase sedative effects of Azelastine (Systemic). Risk C: Monitor

Bedaquiline: Alcohol (Ethyl) may increase hepatotoxic effects of Bedaquiline. Risk X: Avoid

Benperidol: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Biperiden: Alcohol (Ethyl) may increase adverse/toxic effects of Biperiden. Risk C: Monitor

Bismuth Subcarbonate: And Alcohol (Ethyl) may interact via an unclear mechanism. Risk X: Avoid

Blonanserin: CNS Depressants may increase CNS depressant effects of Blonanserin. Management: Use caution if coadministering blonanserin and CNS depressants; dose reduction of the other CNS depressant may be required. Strong CNS depressants should not be coadministered with blonanserin. Risk D: Consider Therapy Modification

Bornaprine: May increase adverse/toxic effects of Alcohol (Ethyl). Risk C: Monitor

Brexanolone: CNS Depressants may increase CNS depressant effects of Brexanolone. Risk C: Monitor

Brimonidine (Topical): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Brivaracetam: Alcohol (Ethyl) may increase CNS depressant effects of Brivaracetam. Risk C: Monitor

Bromocriptine: Alcohol (Ethyl) may increase adverse/toxic effects of Bromocriptine. Risk C: Monitor

Bromopride: May increase sedative effects of Alcohol (Ethyl). Risk X: Avoid

Bromperidol: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Brotizolam: Alcohol (Ethyl) may increase CNS depressant effects of Brotizolam. Risk X: Avoid

Buclizine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Buprenorphine: CNS Depressants may increase CNS depressant effects of Buprenorphine. Management: Consider reduced doses of other CNS depressants, and avoiding such drugs in patients at high risk of buprenorphine overuse/self-injection. Initiate buprenorphine at lower doses in patients already receiving CNS depressants. Risk D: Consider Therapy Modification

BuPROPion: Alcohol (Ethyl) may increase adverse/toxic effects of BuPROPion. Specifically, seizure threshold may be lowered. BuPROPion may increase adverse/toxic effects of Alcohol (Ethyl). Specifically, alcohol tolerance may decrease during treatment. Management: Patients receiving bupropion should be advised to minimize or avoid alcohol consumption due to possible lower alcohol tolerance, and lower seizure threshold associated with heavy alcohol consumption/abrupt discontinuation of heavy consumption. Risk D: Consider Therapy Modification

BusPIRone: May increase sedative effects of Alcohol (Ethyl). Risk C: Monitor

Cannabinoid-Containing Products: CNS Depressants may increase CNS depressant effects of Cannabinoid-Containing Products. Risk C: Monitor

Cannabis: May increase CNS depressant effects of Alcohol (Ethyl). Risk C: Monitor

Cefamandole: Alcohol (Ethyl) may increase adverse/toxic effects of Cefamandole. Risk X: Avoid

Cefbuperazone: May increase adverse/toxic effects of Alcohol (Ethyl). Risk X: Avoid

Cefmetazole: May increase adverse/toxic effects of Alcohol (Ethyl). Management: Consider avoiding alcohol during cefmetazole administration and for at least 1 week after therapy is completed. If alcohol is consumed during cefmetazole therapy, monitor for adverse effects such as flushing, nausea, tachycardia. Risk D: Consider Therapy Modification

Cefminox: May increase adverse/toxic effects of Alcohol (Ethyl). Risk X: Avoid

Cefoperazone: May increase adverse/toxic effects of Alcohol (Ethyl). Risk C: Monitor

CefoTEtan: May increase adverse/toxic effects of Alcohol (Ethyl). Risk C: Monitor

Cefpiramide: Alcohol (Ethyl) may increase adverse/toxic effects of Cefpiramide. Risk X: Avoid

Cetirizine (Systemic): May increase CNS depressant effects of CNS Depressants. Management: Consider avoiding this combination if possible. If required, monitor for excessive sedation or CNS depression, limit the dose and duration of combination therapy, and consider CNS depressant dose reductions. Risk D: Consider Therapy Modification

Chloral Hydrate/Chloral Betaine: CNS Depressants may increase CNS depressant effects of Chloral Hydrate/Chloral Betaine. Management: Consider alternatives to the use of chloral hydrate or chloral betaine and additional CNS depressants. If combined, consider a dose reduction of either agent and monitor closely for enhanced CNS depressive effects. Risk D: Consider Therapy Modification

Chlormethiazole: Alcohol (Ethyl) may increase CNS depressant effects of Chlormethiazole. Management: Monitor for excessive depressant effects with this combination; caution patients about serious CNS depression if used concurrently. Chlormethiazole should not be used in persons with an alcohol use disorder who continue to consume alcohol. Risk D: Consider Therapy Modification

Chlorphenesin Carbamate: Alcohol (Ethyl) may increase adverse/toxic effects of Chlorphenesin Carbamate. Risk C: Monitor

Chlorzoxazone: Alcohol (Ethyl) may increase CNS depressant effects of Chlorzoxazone. Alcohol (Ethyl) may decrease serum concentration of Chlorzoxazone. Specifically, chronic alcohol ingestion may decrease serum concentrations of chlorzoxazone. Risk C: Monitor

Cisapride: May increase adverse/toxic effects of Alcohol (Ethyl). Specifically, Alcohol (Ethyl) sedative and psychomotor effects may be enhanced. Alcohol (Ethyl) may also worsen nocturnal heartburn. Cisapride may increase serum concentration of Alcohol (Ethyl). Risk C: Monitor

CloBAZam: Alcohol (Ethyl) may increase CNS depressant effects of CloBAZam. Alcohol (Ethyl) may increase serum concentration of CloBAZam. Management: Patients taking clobazam should avoid alcohol consumption. If combined, patients should be informed that the CNS depressant effects of alcohol and clobazam may be potentiated. Risk D: Consider Therapy Modification

CloNIDine: Alcohol (Ethyl) may increase CNS depressant effects of CloNIDine. Alcohol (Ethyl) may increase serum concentration of CloNIDine. Specifically, the rate of dissolution from the clonidine extended-release tablet may be enhanced in the presence of alcohol. Risk C: Monitor

CNS Depressants: May increase CNS depressant effects of Alcohol (Ethyl). Risk C: Monitor

CycloSERINE: Alcohol (Ethyl) may increase neurotoxic effects of CycloSERINE. Specifically, the risk for seizures may be increased. Risk X: Avoid

Cyproterone: Alcohol (Ethyl) may decrease therapeutic effects of Cyproterone. More specifically, alcohol may interfere with antiandrogenic effects of Cyproterone. Risk X: Avoid

Cysteamine (Systemic): Alcohol (Ethyl) may increase adverse/toxic effects of Cysteamine (Systemic). Alcohol (Ethyl) may decrease therapeutic effects of Cysteamine (Systemic). Risk X: Avoid

Dantrolene: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Dapoxetine: May increase adverse/toxic effects of Alcohol (Ethyl). Risk X: Avoid

Daridorexant: Alcohol (Ethyl) may increase CNS depressant effects of Daridorexant. Risk X: Avoid

Deferiprone: Alcohol (Ethyl) may increase serum concentration of Deferiprone. Risk X: Avoid

Dexlansoprazole: Alcohol (Ethyl) may decrease serum concentration of Dexlansoprazole. Risk X: Avoid

DexmedeTOMIDine: CNS Depressants may increase CNS depressant effects of DexmedeTOMIDine. Management: Monitor for increased CNS depression during coadministration of dexmedetomidine and CNS depressants, and consider dose reductions of either agent to avoid excessive CNS depression. Risk D: Consider Therapy Modification

Diamorphine: Alcohol (Ethyl) may increase CNS depressant effects of Diamorphine. Risk X: Avoid

Didanosine: Alcohol (Ethyl) may increase adverse/toxic effects of Didanosine. Specifically, the risk of pancreatitis may be increased. Risk X: Avoid

Diethylpropion: Alcohol (Ethyl) may increase adverse/toxic effects of Diethylpropion. Risk C: Monitor

Difelikefalin: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Difenoxin: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Dihydralazine: CNS Depressants may increase hypotensive effects of Dihydralazine. Risk C: Monitor

Dimethindene (Topical): May increase CNS depressant effects of Alcohol (Ethyl). Risk X: Avoid

Diroximel Fumarate: Alcohol (Ethyl) may decrease active metabolite exposure of Diroximel Fumarate. Risk X: Avoid

Disulfiram: May increase adverse/toxic effects of Alcohol (Ethyl). A disulfiram-like reaction may occur. Risk X: Avoid

Dothiepin: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Doxylamine: Alcohol (Ethyl) may increase CNS depressant effects of Doxylamine. Risk X: Avoid

DroNABinol: May increase CNS depressant effects of Alcohol (Ethyl). Risk C: Monitor

DroPERidol: May increase CNS depressant effects of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Risk D: Consider Therapy Modification

Efavirenz: May increase adverse/toxic effects of Alcohol (Ethyl). Specifically, the risk for central nervous system toxicities and hepatotoxicity may be increased. Efavirenz may decrease serum concentration of Alcohol (Ethyl). Risk C: Monitor

Eluxadoline: Alcohol (Ethyl) may increase adverse/toxic effects of Eluxadoline. Specifically, alcohol use may increase the risk of pancreatitis. Risk X: Avoid

Emedastine (Systemic): May increase CNS depressant effects of CNS Depressants. Management: Consider avoiding this combination if possible. If required, monitor for excessive sedation or CNS depression, limit the dose and duration of combination therapy, and consider CNS depressant dose reductions. Risk C: Monitor

Entacapone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Esketamine (Nasal): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Ethionamide: Alcohol (Ethyl) may increase adverse/toxic effects of Ethionamide. Specifically, there may be a risk for a psychotic episode/reaction. Risk C: Monitor

Fesoterodine: Alcohol (Ethyl) may increase CNS depressant effects of Fesoterodine. Risk C: Monitor

Fexinidazole: Alcohol (Ethyl) may increase adverse/toxic effects of Fexinidazole. A disulfiram-like reaction may occur. Risk X: Avoid

Flibanserin: Alcohol (Ethyl) may increase hypotensive effects of Flibanserin. Management: Wait at least 2 hours after consuming 1 or 2 standard alcoholic drinks before taking flibanserin. Skip the flibanserin dose if 3 or more alcoholic drinks were consumed that evening. After taking flibanserin at bedtime, do not drink until the next day. Risk D: Consider Therapy Modification

Flunarizine: CNS Depressants may increase CNS depressant effects of Flunarizine. Risk X: Avoid

Flunitrazepam: Alcohol (Ethyl) may increase CNS depressant effects of Flunitrazepam. Risk X: Avoid

Fosphenytoin-Phenytoin: Alcohol (Ethyl) may decrease serum concentration of Fosphenytoin-Phenytoin. Alcohol (Ethyl) may increase serum concentration of Fosphenytoin-Phenytoin. Risk C: Monitor

Gabapentin Enacarbil: Alcohol (Ethyl) may increase CNS depressant effects of Gabapentin Enacarbil. Alcohol (Ethyl) may increase absorption of Gabapentin Enacarbil. Specifically, the rate of absorption may be enhanced, as alcohol may speed the release of drug from the extended-release tablet. Risk X: Avoid

Ganaxolone: May increase CNS depressant effects of Alcohol (Ethyl). Risk C: Monitor

Griseofulvin: May increase adverse/toxic effects of Alcohol (Ethyl). A disulfiram-like reaction may occur. Risk C: Monitor

GuanFACINE: Alcohol (Ethyl) may increase CNS depressant effects of GuanFACINE. Risk X: Avoid

HYDROcodone: Alcohol (Ethyl) may increase CNS depressant effects of HYDROcodone. Alcohol (Ethyl) may increase serum concentration of HYDROcodone. Management: Patients using hydrocodone extended-release capsules must not consume alcohol or alcohol-containing products due to possibly fatal outcomes. Other hydrocodone products are also expected to interact, but to a less significant degree. Risk X: Avoid

HydrOXYzine: May increase CNS depressant effects of CNS Depressants. Management: Consider a decrease in the CNS depressant dose, as appropriate, when used together with hydroxyzine. Increase monitoring of signs/symptoms of CNS depression in any patient receiving hydroxyzine together with another CNS depressant. Risk D: Consider Therapy Modification

Indoramin: Alcohol (Ethyl) may increase sedative effects of Indoramin. Alcohol (Ethyl) may increase serum concentration of Indoramin. Risk C: Monitor

Isoniazid: Alcohol (Ethyl) may increase hepatotoxic effects of Isoniazid. Risk C: Monitor

ISOtretinoin (Systemic): Alcohol (Ethyl) may increase adverse/toxic effects of ISOtretinoin (Systemic). Specifically, the risk for elevated triglyceride concentrations may be increased. Risk C: Monitor

Ixabepilone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Kava Kava: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Ketoconazole (Systemic): May increase adverse/toxic effects of Alcohol (Ethyl). Specifically, a disulfiram-like reaction to alcohol may occur. Alcohol (Ethyl) may increase hepatotoxic effects of Ketoconazole (Systemic). Risk X: Avoid

Ketotifen (Systemic): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Kratom: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Lemborexant: Alcohol (Ethyl) may increase CNS depressant effects of Lemborexant. Alcohol (Ethyl) may increase serum concentration of Lemborexant. Risk X: Avoid

Lercanidipine: Alcohol (Ethyl) may increase vasodilatory effects of Lercanidipine. Risk X: Avoid

Levocetirizine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Levodopa: Alcohol (Ethyl) may increase serum concentration of Levodopa. Risk X: Avoid

Levoketoconazole: Alcohol (Ethyl) may increase adverse/toxic effects of Levoketoconazole. Specifically, a disulfiram-like reaction may occur. Risk X: Avoid

Levomethadone: Alcohol (Ethyl) may increase adverse/toxic effects of Levomethadone. Specifically, the risk for sedation, respiratory depression, coma, and death may be increased. Risk X: Avoid

Levomilnacipran: Alcohol (Ethyl) may increase absorption of Levomilnacipran. More specifically, Alcohol (Ethyl) may cause more rapid release of Levomilnacipran from extended-release tablets, which could accelerate absorption early post-dose. Risk X: Avoid

Levosulpiride: Alcohol (Ethyl) may increase CNS depressant effects of Levosulpiride. Risk X: Avoid

Lisuride: May increase CNS depressant effects of Alcohol (Ethyl). Risk X: Avoid

Lofepramine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Lofexidine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Lomitapide: Alcohol (Ethyl) may increase hepatotoxic effects of Lomitapide. Management: Advise patients to limit alcohol consumption to 1 drink per day while receiving lomitapide. Risk D: Consider Therapy Modification

LORazepam: Alcohol (Ethyl) may increase CNS depressant effects of LORazepam. Alcohol (Ethyl) may increase serum concentration of LORazepam. Specifically, this increase in concentration would only occur with use of lorazepam extended release capsules and alcohol. Risk C: Monitor

Lormetazepam: Alcohol (Ethyl) may increase CNS depressant effects of Lormetazepam. Risk X: Avoid

Loxapine: CNS Depressants may increase CNS depressant effects of Loxapine. Management: Consider reducing the dose of CNS depressants administered concomitantly with loxapine due to an increased risk of respiratory depression, sedation, hypotension, and syncope. Risk D: Consider Therapy Modification

Magnesium Sulfate: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Mecamylamine: Alcohol (Ethyl) may increase adverse/toxic effects of Mecamylamine. Risk C: Monitor

Melatonin: Alcohol (Ethyl) may decrease therapeutic effects of Melatonin. Alcohol (Ethyl) may increase adverse/toxic effects of Melatonin. Risk X: Avoid

Melitracen [INT]: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Mequitazine: Alcohol (Ethyl) may increase CNS depressant effects of Mequitazine. Risk X: Avoid

Mesalamine: Alcohol (Ethyl) may increase serum concentration of Mesalamine. Management: The Mezera brand of mesalamine should not be administered with alcohol. Caution patients that consuming alcohol while on Mezera may cause too much mesalamine to be released at once. Risk D: Consider Therapy Modification

Metergoline: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

MetFORMIN: Alcohol (Ethyl) may increase adverse/toxic effects of MetFORMIN. Specifically, excessive alcohol ingestion (acute or chronic) may potentiate the risk of lactic acidosis. Risk X: Avoid

Methotrexate: Alcohol (Ethyl) may increase hepatotoxic effects of Methotrexate. Management: Limit alcohol consumption in patients taking methotrexate. The use of methotrexate for the treatment of psoriasis or rheumatoid arthritis is contraindicated in patients with alcoholism or alcoholic liver disease. Risk D: Consider Therapy Modification

Methotrimeprazine: Alcohol (Ethyl) may increase adverse/toxic effects of Methotrimeprazine. Specifically, CNS depressant effects may be increased. Management: Avoid alcohol in patients treated with methotrimeprazine. Risk X: Avoid

Methoxyflurane: Alcohol (Ethyl) may increase CNS depressant effects of Methoxyflurane. Alcohol (Ethyl) may increase metabolism of Methoxyflurane. Specifically, this increased metabolism may lead to increased production of nephrotoxic metabolites. Risk X: Avoid

Methylphenidate: Alcohol (Ethyl) may increase adverse/toxic effects of Methylphenidate. Alcohol (Ethyl) may increase serum concentration of Methylphenidate. Risk X: Avoid

Metoclopramide: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

MetroNIDAZOLE (Systemic): May increase adverse/toxic effects of Alcohol (Ethyl). A disulfiram-like reaction may occur. Risk X: Avoid

MetroNIDAZOLE (Topical): May increase adverse/toxic effects of Alcohol (Ethyl). A disulfiram-like reaction may occur. Risk C: Monitor

MetyroSINE: CNS Depressants may increase sedative effects of MetyroSINE. Risk C: Monitor

Mianserin: May increase CNS depressant effects of Alcohol (Ethyl). Risk C: Monitor

Minocycline (Systemic): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Mirtazapine: Alcohol (Ethyl) may increase CNS depressant effects of Mirtazapine. Risk X: Avoid

Modafinil: Alcohol (Ethyl) may decrease therapeutic effects of Modafinil. Risk X: Avoid

Molsidomine: May increase hypotensive effects of Alcohol (Ethyl). Risk C: Monitor

Monoamine Oxidase Inhibitors: Alcohol (Ethyl) may increase adverse/toxic effects of Monoamine Oxidase Inhibitors. Risk X: Avoid

Morniflumate: Alcohol (Ethyl) may increase adverse/toxic effects of Morniflumate. Specifically, consumption of more than 3 alcoholic drinks per day may increase the risk of gastrointestinal hemorrhage during Morniflumate treatment. Risk C: Monitor

Moxonidine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Nabilone: May increase CNS depressant effects of Alcohol (Ethyl). Risk X: Avoid

Nalfurafine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Nefopam: Alcohol (Ethyl) may increase CNS depressant effects of Nefopam. Risk X: Avoid

Niacin: Alcohol (Ethyl) may increase adverse/toxic effects of Niacin. Management: Avoid alcohol around the time of niacin administration to minimize flushing. Use caution in patients who drink larger amounts of alcohol due to the potential for enhanced hepatotoxicity. Consider monitoring serum transaminases more frequently. Risk D: Consider Therapy Modification

Niclosamide: May increase absorption of Alcohol (Ethyl). Risk X: Avoid

Nicorandil: Alcohol (Ethyl) may increase hypotensive effects of Nicorandil. Risk C: Monitor

NIFEdipine: Alcohol (Ethyl) may increase serum concentration of NIFEdipine. Risk C: Monitor

Nifurtimox: Alcohol (Ethyl) may increase adverse/toxic effects of Nifurtimox. Risk X: Avoid

Nilutamide: May increase adverse/toxic effects of Alcohol (Ethyl). Specifically, nilutamide may increase the likelihood of alcohol intolerance (eg, facial flushing, malaise, hypotension). Risk X: Avoid

Nonsteroidal Anti-Inflammatory Agents (Topical): Alcohol (Ethyl) may increase adverse/toxic effects of Nonsteroidal Anti-Inflammatory Agents (Topical). Specifically, the risk of GI bleeding may be increased with this combination. Risk C: Monitor

Nonsteroidal Anti-Inflammatory Agents: Alcohol (Ethyl) may increase adverse/toxic effects of Nonsteroidal Anti-Inflammatory Agents. Specifically, the risk of GI bleeding may be increased with this combination. Risk C: Monitor

Normethadone: Alcohol (Ethyl) may increase adverse/toxic effects of Normethadone. Risk X: Avoid

Noscapine: CNS Depressants may increase adverse/toxic effects of Noscapine. Risk X: Avoid

Olopatadine (Nasal): May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Ombitasvir, Paritaprevir, Ritonavir, and Dasabuvir: Alcohol (Ethyl) may decrease therapeutic effects of Ombitasvir, Paritaprevir, Ritonavir, and Dasabuvir. Management: Avoid alcohol consumption within 4 hours of taking the extended-release ombitasvir/paritaprevir/ritonavir/dasabuvir product. This interaction does not apply to the immediate-release ombitasvir/paritaprevir/ritonavir/dasabuvir product. Risk D: Consider Therapy Modification

Opicapone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Opioid Agonists: CNS Depressants may increase CNS depressant effects of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Risk D: Consider Therapy Modification

Opipramol: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Ornidazole: May increase adverse/toxic effects of Alcohol (Ethyl). A disulfiram-like reaction may occur. Management: Consider advising patients to avoid alcohol consumption with ornidazole or within 3 days after stopping ornidazole. Some product labels recommend avoiding this combination while other labels say there is no interaction between ornidazole and alcohol. Risk D: Consider Therapy Modification

Orphenadrine: Alcohol (Ethyl) may increase CNS depressant effects of Orphenadrine. Risk X: Avoid

OXcarbazepine: Alcohol (Ethyl) may increase CNS depressant effects of OXcarbazepine. Risk C: Monitor

Oxomemazine: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Oxybate Salt Products: Alcohol (Ethyl) may increase CNS depressant effects of Oxybate Salt Products. Alcohol (Ethyl) may increase serum concentration of Oxybate Salt Products. Specifically, alcohol may increase concentrations of the sodium oxybate extended release suspension. Risk X: Avoid

OxyBUTYnin: Alcohol (Ethyl) may increase CNS depressant effects of OxyBUTYnin. Risk C: Monitor

OxyCODONE: CNS Depressants may increase CNS depressant effects of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Risk D: Consider Therapy Modification

Paliperidone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Paraldehyde: CNS Depressants may increase CNS depressant effects of Paraldehyde. Risk X: Avoid

Perampanel: May increase CNS depressant effects of Alcohol (Ethyl). Alcohol may also worsen the negative behavioral and psychiatric effects of Perampanel. Risk X: Avoid

Perazine: Alcohol (Ethyl) may increase CNS depressant effects of Perazine. Alcohol (Ethyl) may increase hypotensive effects of Perazine. Risk C: Monitor

Periciazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Pheniramine: Alcohol (Ethyl) may increase CNS depressant effects of Pheniramine. Management: Caution patients to avoid the use of alcohol together with pheniramine. Risk D: Consider Therapy Modification

Phentermine: Alcohol (Ethyl) may increase adverse/toxic effects of Phentermine. Risk C: Monitor

Phosphodiesterase 5 Inhibitors: Alcohol (Ethyl) may increase hypotensive effects of Phosphodiesterase 5 Inhibitors. Risk C: Monitor

Pimecrolimus: Alcohol (Ethyl) may increase dermatologic adverse effects of Pimecrolimus. Risk C: Monitor

Pipamperone: May increase adverse/toxic effects of Alcohol (Ethyl). Specifically, sedative and psychomotor effects may be enhanced. Risk C: Monitor

Piribedil: Alcohol (Ethyl) may increase sedative effects of Piribedil. Risk X: Avoid

Pizotifen: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Posaconazole: Alcohol (Ethyl) may increase serum concentration of Posaconazole. Risk X: Avoid

Pramipexole: CNS Depressants may increase sedative effects of Pramipexole. Risk C: Monitor

Pretomanid: Alcohol (Ethyl) may increase hepatotoxic effects of Pretomanid. Risk X: Avoid

Procarbazine: May increase adverse/toxic effects of Alcohol (Ethyl). A disulfiram-like reaction may occur. Alcohol (Ethyl) may increase CNS depressant effects of Procarbazine. Risk X: Avoid

Propacetamol: Alcohol (Ethyl) may increase hepatotoxic effects of Propacetamol. Risk C: Monitor

Propranolol: Alcohol (Ethyl) may decrease serum concentration of Propranolol. Alcohol (Ethyl) may increase serum concentration of Propranolol. Risk C: Monitor

Prothionamide: Alcohol (Ethyl) may increase adverse/toxic effects of Prothionamide. Risk X: Avoid

Quinagolide: Alcohol (Ethyl) may increase adverse/toxic effects of Quinagolide. Risk C: Monitor

Ranolazine: Alcohol (Ethyl) may increase serum concentration of Ranolazine. Risk X: Avoid

Rilmenidine: Alcohol (Ethyl) may increase adverse/toxic effects of Rilmenidine. Specifically, alcohol increased the CNS depressant effect of rilmenidine. Risk X: Avoid

Ropeginterferon Alfa-2b: CNS Depressants may increase adverse/toxic effects of Ropeginterferon Alfa-2b. Specifically, the risk of neuropsychiatric adverse effects may be increased. Management: Avoid coadministration of ropeginterferon alfa-2b and other CNS depressants. If this combination cannot be avoided, monitor patients for neuropsychiatric adverse effects (eg, depression, suicidal ideation, aggression, mania). Risk D: Consider Therapy Modification

ROPINIRole: CNS Depressants may increase sedative effects of ROPINIRole. Risk C: Monitor

Rotigotine: CNS Depressants may increase sedative effects of Rotigotine. Risk C: Monitor

Rufinamide: Alcohol (Ethyl) may increase adverse/toxic effects of Rufinamide. Specifically, sleepiness and dizziness may be enhanced. Risk C: Monitor

Secnidazole: Alcohol (Ethyl) may increase adverse/toxic effects of Secnidazole. Risk X: Avoid

Selective Serotonin Reuptake Inhibitor: Alcohol (Ethyl) may increase adverse/toxic effects of Selective Serotonin Reuptake Inhibitor. Specifically, the risk of psychomotor impairment may be enhanced. Management: Patients receiving selective serotonin reuptake inhibitors should be advised to avoid alcohol. Monitor for increased psychomotor impairment in patients who consume alcohol during treatment with selective serotonin reuptake inhibitors. Risk D: Consider Therapy Modification

Serotonin/Norepinephrine Reuptake Inhibitor: Alcohol (Ethyl) may increase hepatotoxic effects of Serotonin/Norepinephrine Reuptake Inhibitor. Particularly duloxetine and milnacipran. Management: Consider advising patients to avoid concomitant use of alcohol with SNRIs, particularly those using extended-release SNRI formulations, due to the risk of accelerated drug release. Heavy alcohol use has been associated with overdose and hepatotoxicity. Risk D: Consider Therapy Modification

Stiripentol: May increase sedative effects of Alcohol (Ethyl). Risk X: Avoid

Sulfonylureas: May increase adverse/toxic effects of Alcohol (Ethyl). A flushing reaction may occur. Alcohol (Ethyl) may increase hypoglycemic effects of Sulfonylureas. Risk C: Monitor

Sulpiride: Alcohol (Ethyl) may increase adverse/toxic effects of Sulpiride. Risk X: Avoid

Sulthiame: May increase adverse/toxic effects of Alcohol (Ethyl). Specifically, concurrent use may result in a disulfiram-like reaction. Risk X: Avoid

Suvorexant: Alcohol (Ethyl) may increase CNS depressant effects of Suvorexant. Risk X: Avoid

Tacrolimus (Systemic): Alcohol (Ethyl) may increase absorption of Tacrolimus (Systemic). More specifically, the initial absorption rate may be increased, as alcohol may speed the release of tacrolimus from extended-release tablets. Management: Advise patients receiving extended-release tacrolimus (Astagraf XL or Envarsus XR brands) not to take the medication with alcoholic beverages. Risk D: Consider Therapy Modification

Tacrolimus (Topical): Alcohol (Ethyl) may increase dermatologic adverse effects of Tacrolimus (Topical). Risk C: Monitor

Tapentadol: Alcohol (Ethyl) may increase CNS depressant effects of Tapentadol. Alcohol (Ethyl) may increase serum concentration of Tapentadol. Specifically, alcohol may increase the maximum serum concentrations when used with extended-release tapentadol. Risk X: Avoid

Tetrahydrocannabinol: May increase CNS depressant effects of Alcohol (Ethyl). Risk C: Monitor

Thalidomide: CNS Depressants may increase CNS depressant effects of Thalidomide. Risk X: Avoid

Theophylline: Alcohol (Ethyl) may increase serum concentration of Theophylline. Risk C: Monitor

Thiazide and Thiazide-Like Diuretics: Alcohol (Ethyl) may increase orthostatic hypotensive effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Tiapride: Alcohol (Ethyl) may increase CNS depressant effects of Tiapride. Risk X: Avoid

Tinidazole: May increase adverse/toxic effects of Alcohol (Ethyl). A disulfiram-like reaction may occur. Risk X: Avoid

Tiopronin: Alcohol (Ethyl) may increase bioavailability of Tiopronin. Risk C: Monitor

Topiramate: Alcohol (Ethyl) may increase CNS depressant effects of Topiramate. Alcohol (Ethyl) may increase serum concentration of Topiramate. This applies specifically to use with one extended-release topiramate product (Trokendi XR). Also, topiramate concentrations may be subtherapeutic in the later portion of the dosage interval. Management: Concurrent use of alcohol within 6 hours of ingestion of extended-release topiramate (Trokendi XR) is contraindicated. Any use of alcohol with other topiramate products should be avoided when possible and should only be undertaken with extreme caution. Risk X: Avoid

Trabectedin: Alcohol (Ethyl) may increase hepatotoxic effects of Trabectedin. Risk X: Avoid

TraZODone: Alcohol (Ethyl) may increase adverse/toxic effects of TraZODone. Specifically, effects on sleepiness, dizziness, and manual dexterity may be enhanced. Risk C: Monitor

Trimeprazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Trimethobenzamide: Alcohol (Ethyl) may increase CNS depressant effects of Trimethobenzamide. Risk X: Avoid

Trospium: Alcohol (Ethyl) may increase CNS depressant effects of Trospium. Management: Avoid consuming any alcohol within 2 hours of taking a dose of trospium XR. Alcohol may increase sedation and CNS depressant effects of trospium XR. Risk D: Consider Therapy Modification

Urapidil: Alcohol (Ethyl) may increase hypotensive effects of Urapidil. Risk C: Monitor

Valerian: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Varenicline (Systemic): May increase adverse/toxic effects of Alcohol (Ethyl). Specifically, alcohol tolerance may be decreased and the risk for neuropsychiatric adverse effects may be increased. Risk C: Monitor

Vasodilators (Organic Nitrates): Alcohol (Ethyl) may increase vasodilatory effects of Vasodilators (Organic Nitrates). Risk C: Monitor

Vitamin K Antagonists: Alcohol (Ethyl) may increase anticoagulant effects of Vitamin K Antagonists. Risk C: Monitor

Zolpidem: CNS Depressants may increase CNS depressant effects of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol. Risk D: Consider Therapy Modification

Zopiclone: Alcohol (Ethyl) may increase CNS depressant effects of Zopiclone. Alcohol (Ethyl) may increase adverse/toxic effects of Zopiclone. Specifically, taking alcohol with zopiclone may increase the risk of complex sleep-related behaviors (eg, sleep-driving, eating food, making phone calls, leaving the house) Risk X: Avoid

Zuranolone: May increase CNS depressant effects of CNS Depressants. Management: Consider alternatives to the use of zuranolone with other CNS depressants or alcohol. If combined, consider a zuranolone dose reduction and monitor patients closely for increased CNS depressant effects. Risk D: Consider Therapy Modification

Reproductive Considerations

Since a "safe" amount of ethanol consumption during pregnancy has not been determined, the AAP recommends women who are planning a pregnancy refrain from all ethanol intake (AAP 2000).

Pregnancy Considerations

Ethanol crosses the placenta, enters the fetal circulation, and has teratogenic effects in humans (AAP 2000; Barceloux 1999).

The following withdrawal symptoms have been noted in the neonate following maternal ethanol consumption during pregnancy: Crying, hyperactivity, irritability, poor suck, tremors, seizures, poor sleeping pattern, hyperphagia, and diaphoresis (Hudak 2012). Fetal alcohol syndrome (FAS) is a term referring to a combination of physical, behavioral, and cognitive abnormalities resulting from ethanol exposure during fetal development. Since a "safe" amount of ethanol consumption during pregnancy has not been determined, the AAP recommends those women who are pregnant refrain from all ethanol intake (AAP 2000).

When used as an antidote during the second or third trimester, FAS is not likely to occur due to the short treatment period; use during the first trimester is controversial (Barceloux 1999). Following administration into a septal artery during percutaneous transluminal septal myocardial ablation, systemic concentrations are not expected to result in significant exposure of ethanol to the fetus, however the procedure should be postponed until after delivery when possible.

Monitoring Parameters

Ethylene glycol or methanol ingestion: Blood ethanol levels (at the end of the loading dose, every 1 to 2 hours until stabilized, and then every 2 to 4 hours thereafter); blood glucose, electrolytes (including serum magnesium), arterial pH, blood gases, methanol or ethylene glycol blood levels, heart rate, blood pressure.

Reference Range

Symptoms associated with serum ethanol levels:

Nausea and vomiting: Serum level >100 mg/dL (SI: >21.7 mmol/L)

Coma: Serum level >300 mg/dL (SI: >65.1 mmol/L)

Antidote for methanol/ethylene glycol: Goal range: Blood ethanol level: 100 to 150 mg/dL (SI: 21.7 to 32.6 mmol/L)

Mechanism of Action

Ethylene glycol or methanol toxicity (off-label use): Ethyl alcohol competitively inhibits alcohol dehydrogenase (AD), an enzyme that catalyzes the metabolism of ethylene glycol and methanol to their toxic metabolites. AD has a higher affinity for ethanol; therefore, ethanol is preferentially metabolized in patients who have ingested ethylene glycol and/or methanol. As a result, treatment with ethanol prevents the formation of ethylene glycol and methanol toxic metabolites, thereby preventing the development of toxicity.

Neurolysis: Alcohol will destroy nerves at the site of injection.

Septal ablation: Tissue toxin that produces a myocardial infarction when injected through an intra-arterial catheter into a target septal vessel, which causes the hypertrophied septum to thin.

Pharmacokinetics (Adult Data Unless Noted)

Absorption: Oral: Rapid (Barceloux 2002).

Distribution: V_d: 0.6 to 0.7 L/kg; may be slightly decreased in women (Barceloux 1999; Barceloux 2002).

Metabolism: Hepatic (90% to 98%) (Barceloux 1999; Barceloux 2002) to acetaldehyde then acetate (Zakhari 2006).

Half-life elimination: Rate: 15 to 20 mg/dL/hour (range: 10 to 34 mg/dL/hour); increased in patients with alcohol use disorder (Barceloux 1999; Barceloux 2002).

Excretion: Kidneys and lungs (~2% to 10% unchanged) (Barceloux 1999; Barceloux 2002).

Brand Names: International

International Brand Names by Country

For country code abbreviations (show table)

(AR) Argentina: By derm alcohol | Dg 6 alcohol | Germikill | Merthiolate alcohol | Sanitizante;
(AU) Australia: Alcohol dehydrated | Bactol alcohol gel | Microshield antimicrobial;
(BR) Brazil: Alcool;
(CL) Chile: Alcohol;
(CO) Colombia: Akuel | Alcohol etilico | Alcohol gel;
(DE) Germany: Fugaten | Septoman;
(DO) Dominican Republic: Manitas limpias;
(EC) Ecuador: Alcohol antiseptico | Alcohol mk | Gel alcohol antiseptico | Inpro;
(EE) Estonia: Aniosgel 85 npc | Chemisept fg;
(GB) United Kingdom: Alcowipes | Levermed | Primahex | Primasol | Purell;
(HK) Hong Kong: Quicklean;
(HU) Hungary: Naksol;
(ID) Indonesia: Handy clean;
(LT) Lithuania: Chemisept fg | Naksol;
(LV) Latvia: Aniosgel 85 npc | Chemisept fg | Chemisept vir+ | Naksol | Septivon Handgel;
(MY) Malaysia: Aniosgel 85 npc | Septi gel;
(NZ) New Zealand: Microshield;
(PR) Puerto Rico: Alcohol dehydrated | Dehydrated alcohol;
(PT) Portugal: Aniosgel 85 npc;
(QA) Qatar: Dehydrated Alcohol;
(RU) Russian Federation: Naksol;
(SG) Singapore: Alcohol dehydrated | Joycare alcohol swab;
(TH) Thailand: Alcohol | Quicklean;
(TN) Tunisia: Curethyl;
(TW) Taiwan: Bio Seeds | Disinfection | Hand sanitizer

Ablysinol (dehydrated alcohol) [prescribing information]. Largo, FL: Belcher Pharmaceuticals; June 2018.
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Topic 13289 Version 317.0

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Ethanol (topical and injection): Pediatric drug information