What's That Alcohol Doing in My Medicine?

By Hecht, Annabel | FDA Consumer, November 1984 | Go to article overview

What's That Alcohol Doing in My Medicine?


Hecht, Annabel, FDA Consumer


If you take your medicine in liquid form, with each spoonful you'll get the active ingredient--the chemical that's going to cure or relieve your symptoms--an assortment of inactive ingredients such as coloring and flavors, and, very likely, some alcohol.

Alcohol? In drugs?

Surprising as this may screen, alcohol appears in varying amounts in hundreds of liquid preparations, both prescription and over-the-counter (OTC) drugs. A lot of these are cough and cold medications taken by all members of the family. While this is not a cause for alarm--the alcohol serves a useful purpose--it is something consumers should be aware of, for there are times when even a little alcohol in a drug could have serious consequences--especially for youngsters.

Parents may wonder if drug companies put alcohol in cough medicine to make tiny tots into topers. Not in this day and age, although that might well have been the case before the enactment of federal food and drug laws. Patent medicines (as OTC drugs--often sold at traveling medicine shows--used to be called) were liberally laced with alcohol and narcotics. Even the indomitable Lydia Pinkham fortified her vegetable compound with 20 percent alcohol (since reduced to 13.5 percent).

Despite the name, most "patent" medicines were not in fact patented. Manufacturers patented the distinctive shape of the bottle but not the contents, thus avoiding a revelation of their secret formulas. The alcohol in drugs can no longer be a secret, however. To combat the abuses of the patent medicine hucksters, the 1906 Food and Drugs Act required that the quantity, kind and proportion of alcohol in a drug had to be disclosed on the label, or else the product would be considered misbranded.

Today, a person taking an OTC drug can find out if there is alcohol in it simply by reading the label. The alcohol content of prescription drugs is included in the professional labeling (information prepared for doctors, pharmacists and other health-care personnel), and in most cases this information also can be found in such reference books as the Physicians' Desk Reference.

Alcohol is most often used in drugs because it is an excellent solvent, in some ways better than water for keeping the other ingredients dissolved in the proper liquid form. Preparations made with alcohol will keep almost indefinitely while many made with water will not.

How much alcohol is used as a solvent in a drug product depends on the solubility of the active ingredients. Some dissolve better in water, while others are more soluble in alcohol. Thus, one liquid product may have less than 1 percent alcohol and another, such as the cough medicine elixir terpin hydrate, as much as 44 percent. Compound benzoin tincture, used to protect irritated tissues in the mouth, contains 64 to 80 percent alcohol, the amouht needed to dissolve the active ingredient. Concentrations of alcohol up to 35 percent are used in many mouthwashes.

Alcohol has other properties that make it medicinally useful. Alcohol may be included in a drug for its astringent effect in helping to stop bleeding or other secretions. Because it can kill bacteria, it is used to clean and disinfect minor wounds. Alcohol sponge baths have been used to reduce fever because of alcohol's cooling effect as it evaporates. Alcohol increases blood flow when it is rubbed on the surface of the skin, making it an effective ingredient in some liniments.

Two kinds of alcohol are most often used in drugs: ethyl alcohol (also called ethanol or simply alcohol) and isopropyl alcohol (isopropanol). Both have similar solvent properties, although isopropanol may be preferred in some manufacturing processes because it contains less water. However, isopropanol can't be taken internally, so it is used only in products such as lotions ro liniments that are applied to the skin.

While any liquid preparation might contain alcohol, those that are called elixirs must, by definition, include this ingredient. …

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