Ethanol
alcohol
What it isAlcohol; a GABA-A positive modulator and NMDA antagonist.
Why this oneIt is the reference intoxicant, and its dual mechanism explains both the sedation and the withdrawal excitability.
What limits itWithdrawal is dangerous where opioid withdrawal is not, because unopposed glutamatergic rebound causes seizures and delirium.
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Percutaneous transluminal septal myocardial ablation (PTSMA) in hypertrophic obstructive cardiomyopathy — reduce LV outflow tract gradient | adult | 1–2 mL injected over 1–2 min into septal arterial branch (usually sufficient) | Minimum dose achieving desired gradient reduction | 5 mL per procedure |
Renal Undefined
Hepatic Undefined
Intra-arterial use during PTSMA only; dose guided by LVOT pressure-gradient assessment.
Instructions
- Administer only under supervision of a qualified interventional cardiologist experienced in PTSMA
- Inspect visually — should be clear and colorless; discard unused portion
- Temporary pacing wire routinely inserted before injection (transient heart block common); remove if no high-degree AV block
- Continuous ECG monitoring for 48 h after the procedure; monitor for heart failure, chest pain, arrhythmias for several days
Available strengths
- inj 1 mL/mL
- drops 950 mg/mL
- sol 70 %
- susp 70 mL/100 mL
- susp 950 mg/mL
- cream 62, 80 mL/100 mL
- cream 0.62 mL/mL
- dressing 75 mL/100 mL
- + 58 other marketed forms not shown
Cautions
- Transient heart block common at injection; ~10% of complete heart block becomes permanent, requiring pacemaker (34% pacemaker dependency in patients >60 y)
- Creates a controlled myocardial infarction — excessive necrosis and heart failure reported (risk rises with alcohol volume and number of septal branches injected)
- Ventricular tachycardia/fibrillation requiring cardioversion (~1%)
Adverse reactions
- Heart block
- Ventricular tachycardia and ventricular fibrillation; other arrhythmias
Pregnancy Not recommended during pregnancy; postpone PTSMA until postpartum when possible (fetal exposure not expected from septal injection).
Lactation Breastfeeding not expected to expose the child; systemic alcohol concentrations not significantly increased.
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 1 mL/mL | inj | per unit | not offered |
NO BOXED WARNINGS
Principal riskWithdrawal causes seizures and delirium, unlike opioid withdrawal
Classes and tags
Clinical profile
Defining liabilityIntoxication, respiratory depression and exposure-dependent developmental toxicity