Dehydrated Alcohol
Class: Sclerosing Agents
Chemical Name: ethanol
Molecular Formula: C2H6O
CAS Number: 121182-78-3
Brands: Ablysinol
Introduction
Dehydrated alcohol is a sclerosing agent.
Uses for Dehydrated Alcohol
Dehydrated alcohol has the following uses:
Dehydrated alcohol is an sclerosing agent indicated to induce controlled cardiac septal infarction to improve exercise capacity in adults with symptomatic hypertrophic obstructive cardiomyopathy who are not candidates for surgical myectomy.
Dehydrated Alcohol Dosage and Administration
General
Dehydrated alcohol is available in the following dosage form(s) and strength(s):
Injection: 1 mL or 5 mL of ethyl alcohol ≥99% by volume as a clear, colorless liquid in a single-dose glass ampul.
Dosage
It isessentialthat the manufacturer's labeling be consulted for more detailed information on dosage and administration of this drug. Dosage summary:
Adults
Dosage and Administration
Inject small volumes over 1 to 2 minutes percutaneously into septal arterial branches, using the minimal dose necessary to achieve the desired reduction in peak left ventricular outflow tract pressure gradient.
In most situations, a dose of 1 mL to 2 mL is sufficient. The maximum dose that should be used in a single procedure is 5 mL.
Cautions for Dehydrated Alcohol
Contraindications
None.
Warnings/Precautions
Heart Block
Transient Heart Block: Transient heart block is common at the time of dehydrated alcohol injection into a septal artery. Prior to the injection, a temporary pacing wire is routinely inserted into the apex of the right ventricle, usually via the femoral vein, to treat transient heart block. The pacing lead can be removed if no episode of high-degree atrioventricular block occurs, usually after several hours of observation following percutaneous transluminal septal myocardial ablation.
Persistent Heart Block: Approximately 10% of complete heart block events become permanent and require placement of a permanent pacemaker following percutaneous transluminal septal myocardial ablation. Risk factors for permanent pacemaker dependency after septal ablation 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, 3rd degree atrioventricular block occurring during the procedure, and no clinical recovery between 12–48 hours after the procedure.
Myocardial Infarction
Injection of dehydrated alcohol is intended to create a controlled myocardial infarction 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.
