Published: 6 September 2018
Revised: 19 October 2018

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Some Asthma Inhalers Contain Very Small Amounts of Ethanol

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

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 MDIs^1,2.

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 guidelines^5,6.

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).