Published: 6 September 2018
Revised: 19 October 2018

Publications

Some Asthma Inhalers Contain Very Small Amounts of Ethanol

Prescriber Update 39(3): 37–38
September 2018

Key Messages

  • Ethanol is present in some metered dose inhalers.
  • The quantity of ethanol released per actuation is very small (less than 10 mg), and is less than the ethanol content in a ripe banana (40 mg).
  • The amount of ethanol is too low to have a pharmacological effect.


Medsafe has recently been contacted by health care professionals regarding the inclusion of ethanol in some metered dose inhalers (MDIs) for asthma. Medsafe and PHARMAC have previously responded to questions about ethanol in MDIs1,2.

Ethanol is added to some MDIs to increase the solubility of the active ingredient. Ethanol has been used as an excipient in asthma MDIs since the late 1990s.

How much ethanol is in a metered dose inhaler?

The quantity of alcohol per actuation (puff) is very small – less than 10 mg.

Table 1 shows the ethanol content in asthma MDIs that are currently available in New Zealand, and for comparison, the amount of ethanol in a ripe banana3 and a standard alcoholic drink4. There is considerably more ethanol in a ripe piece of fruit than in one actuation from an MDI. The amount of ethanol per actuation is too small to have a pharmacological effect.

Continue to use asthma inhalers according to the data sheets and clinical guidelines5,6.

Table 1: Ethanol content of currently available aerosol metered dose inhalers for asthma, and comparator food and drink items

Metered dose inhalers
Active ingredient Brand name Strength of active ingredient (mcg) Ethanol quantity (mg) per actuation
Beta2 agonists
Salbutamol Respigen 100 4.1
SalAir 100 1.5
Ventolin 100 nil
Antimuscarinic bronchodilators
Ipratropium Atrovent 20 8.4
Inhaled corticosteroids
Beclometasone dipropionate Beclazone 50 2.1
100 3.1
250 6.0
Qvar 50 4.7
100 4.7
Fluticasone Flixotide 125 nil
Flixotide Junior 50 nil
Floair 50 1.6
125 1.6
Long-acting beta-agonists
Salmeterol Serevent 25 nil
Meterol 25 1.6
Combination preventer products
Fluticasone/salmeterol Seretide 50/25 nil
125/25 nil
250/25 nil
Rexair 50/25 1.6
125/25 1.6
250/25 1.6
Budesonide/formoterol Vannair 100/6 nil
200/6 nil
Mast cell stabilisers
Sodium cromoglycate Intal Forte 5000 nil
Nedocromil Tilade 2000 nil
Comparator food and drink itemsa,b
Food or drink Ethanol quantity (mg) per item
Ripe banana (100 g) 40.0
One standard unit of alcohol 10,000.0
  1. Gorgus E, Hittinger M, Schrenk D. 2016. Estimates in ethanol exposure in children from food not labeled as alcohol-containing. Journal of Analytical Toxicology 40(7): 537–42. URL: www.ncbi.nlm.nih.gov/pmc/articles/PMC5421578/ (accessed 10 May 2018).
  2. Ministry of Health. 2017. Alcohol. URL: www.health.govt.nz/your-health/healthy-living/addictions/alcohol-and-drug-abuse/alcohol (accessed 10 May 2018).
References
  1. Medsafe. 2005. Salamol inhalers – New Zealand brand switching complaints investigation. URL: www.medsafe.govt.nz/hot/PapersReports/Salamol.asp (accessed 10 May 2018).
  2. PHARMAC. 2005. PHARMAC responds on salbutamol. New Zealand Medical Journal 118(1221): 112–20. URL: www.nzma.org.nz/__data/assets/pdf_file/0007/17917/Vol-118-No-1221-26-August-2005.pdf (accessed 11 May 2018).
  3. Gorgus E, Hittinger M, Schrenk D. 2016. Estimates in ethanol exposure in children from food not labeled as alcohol-containing. Journal of Analytical Toxicology 40(7): 537–42. URL: www.ncbi.nlm.nih.gov/pmc/articles/PMC5421578/ (accessed 10 May 2018).
  4. Ministry of Health. 2017. Alcohol. URL: www.health.govt.nz/your-health/healthy-living/addictions/alcohol-and-drug-abuse/alcohol (accessed 10 May 2018).
  5. Asher I, McNamara D, Davies C, et al. 2017. Asthma and Respiratory Foundation NZ child and adolescent asthma guidelines: a quick reference guide. New Zealand Medical Journal 130(1466): 10–33. URL: www.nzasthmaguidelines.co.nz/childguidelines-654716.html (accessed 10 May 2018).
  6. Beasley R, Hancox RJ, Harwood M, et al. 2016. Asthma and Respiratory Foundation NZ adult asthma guidelines: a quick reference guide. New Zealand Medical Journal 129(1445): 83–102. URL: www.nzasthmaguidelines.co.nz/adultguidelines.html (accessed 10 May 2018).
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