Ethamolin (Ethanolamine oleate) is a sclerosant agent that is injected directly into the dilated tortuous veins (varix, varices) of the esophagus or stomach in patients with portal hypertension or liver fibrosis. It causes an inflammatory reaction in the walls of the varix resulting in fibrosis and occlusion of the vessels.

Ethamolin (Ethanolamine oleate) Uses:

• Esophageal varices:

  • It is indicated for the treatment of esophageal varices that has recently bled to prevent rebleeding episodes.

Ethamolin dose in Adults

Ethamolin dose in the treatment of Esophageal varices:

• 1.5 to 5 mL per varix.
• The maximum dose should not exceed 20 mL per treatment session.
• The treatment session is usually recommended at the time of acute variceal bleeding and then repeated after one week, six weeks, three months, and six months as indicated.
• Note:
  • Patients with cardiopulmonary disease and advanced liver disease should receive less than the recommended maximum dose.

Dose in children:

Not indicated.

Pregnancy Risk Factor: C

• Animal reproduction studies have not included any study of the drug.

Use of ethanolamine oilate during breastfeeding

• It is unknown if the drug will be excreted into breastmilk.
• The manufacturer suggests that breastfeeding mothers use the drug with caution.

Dose in Kidney Disease:

In the manufacturer's labeling, an adjustment in the dose in patients with renal impairment has not been provided.

Ethamolin Dose in Liver disease:

• The manufacturer has not provided any dosing recommendations in patients with liver disease.
• However, a lower dose should be used in patients with advanced liver disease (Child-Pugh Class C).

Side Effects of Ethanolamine oleate (Ethamolin):

• Cardiovascular:

  • Substernal pain

• Gastrointestinal:

  • Esophageal ulcer
  • Esophageal stenosis

• Respiratory:

  • Pleural effusion
  • Pneumonia

• Miscellaneous:

  • Fever

Contraindications to Ethanolamine oleate (Ethamolin):

Allergic reaction to ethanolamine or oleic acid, ethanolamine-oleate, and any component of the formulation.

Warnings and precautions

• Anaphylaxis

  • Anaphylactic shock can be caused by anaphylactic reaction to the injection of more sclerosant.

• Injection necrosis:

  • The injection of sclerosing agents can cause necrosis.
  • This can happen especially if the patient is receiving a large amount of injections.
  • There have been cases of severe and fatal esophageal necrosis that led to death.

• Effects on the renal system:

  • However, it was reported that patients with acute renal failure experienced spontaneous recovery.

• Cardiorespiratory disease

  • Patients suffering from cardiorespiratory disease should be closely monitored and treated with caution.
  • Additionally, it is important to reduce the dose per session.

• Hepatic impairment

  • Patients with advanced liver disease ( Child Pugh Class C) will need to take a lower dose than usual. These patients are more at risk for esophageal bleeding and ulceration.

Monitoring Parameters:

Observe the patient for retrosternal chest pain and signs of upper GI bleed (melena, hypotension, and tachycardia).

How to administer Ethanolamine oleate (Ethamolin)?

• Proper injection technique is important to avoid mucosal necrosis (that may result in the direct injection of sclerosant agents).
• Avoid excessive volume and submucosal injection to reduce the risk of ulceration.

Mechanism of action of Ethanolamine oleate (Ethamolin):

Ethanolamine-oleate causes vein occlusion by producing a dose related inflammatory response, which results in fibrosis. Fibrosis is caused by the drug diffusing through the vessel walls.

International Brand Names of Ethanolamine oleate:

• Ethamolin

Ethanolamine oleate Brand Names in Pakistan:

No Brands Available in Pakistan.