Water for injection

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Water for injection - Wikipedia

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Water for injection
Clinical data
Sterile water for injection
AHFS/Drugs.com	FDA Professional Drug Information
License data	US DailyMed: Water_for_injection
ATC code	V07AB (WHO)
Identifiers
CAS Number	7732-18-5
ChemSpider	937
UNII	059QF0KO0R
Chemical and physical data
Formula	H₂O

Water for injection is water of extra high quality without significant contamination.^[1] A sterile version is used for making solutions that will be given by injection.^[2] Before such use other substances generally must be added to make the solution isotonic.^[3] Isotonic solutions containing water for injection can be given by injection into a vein, muscle, or under the skin.^[4] A non-sterile version may be used in manufacturing with sterilization occurring later in the production process.^[5]

Side effects and mechanisms

The primary use of sterile water for injection is as an ingredient for dilution of other medications (aseptic preparation of parenteral solutions).^[6] If it is given by injection into a vein without making it approximately isotonic, breakdown of red blood cells may occur.^[3] This can then result in kidney problems.^[3] Excessive amount may also result in fluid overload.^[4] Water for injection is generally made by distillation or reverse osmosis.^[5] It should contain less than a mg of elements other than water per 100 ml.^[5] Versions with agents that stop bacterial growth are also available.^[5]

In the UK, some hospitals offer subcutaneous injections of water directly for treating back pain in labour. It is controversial, with some claiming it is pseudoscience.^[7] Because sterile water is not isotonic, its injection causes acute pain.^[8] One purported mechanism of action is to induce acute local pain to compete directly with diffuse back pain through a mechanism called diffuse noxious inhibitory control; another hypothesis is instead that the acute pain releases endorphins.^[8] A review and meta-analysis in 2009 found the benefits of its use inconclusive.^[8]

History and culture

It is on the World Health Organization's List of Essential Medicines.^[9] Water for injection is available over the counter in the United States.^[3]

Other names

Water for injection is also known as aqua ad iniectabilia or aqua ad injectionem.

References

^ "<1231> Water for Pharmaceutical Purposes" (PDF). hmc.usp.org. p. 2. Archived from the original (PDF) on 11 March 2015. Retrieved 14 January 2017.
^ World Health Organization (2009). Stuart MC, Kouimtzi M, Hill SR (eds.). WHO Model Formulary 2008. World Health Organization. p. 493. hdl:10665/44053. ISBN 9789241547659.
^ ^a ^b ^c ^d "Sterile Water for Injection - FDA prescribing information, side effects and uses". Drugs.com. Archived from the original on 18 January 2017. Retrieved 14 January 2017.
^ ^a ^b "Water for Injection - FDA prescribing information, side effects and uses". Drugs.com. Archived from the original on 16 July 2017. Retrieved 14 January 2017.
^ ^a ^b ^c ^d Ghosh TK, Jasti BR (2004). Theory and Practice of Contemporary Pharmaceutics. CRC Press. p. 396. ISBN 9780203644478. Archived from the original on 16 January 2017.
^ "Sterile Water for Injection, USP" (PDF). Baxter Corporation. U.S. Food and Drug Administration. September 2014.
^ Lintern S (27 November 2022). "Water jabs and burning herbs offered during natural births at NHS hospitals". The Times. ISSN 0140-0460. Retrieved 30 September 2023.
^ ^a ^b ^c Hutton EK, Kasperink M, Rutten M, Reitsma A, Wainman B (August 2009). "Sterile water injection for labour pain: a systematic review and meta-analysis of randomised controlled trials". BJOG. 116 (9): 1158–1166. doi:10.1111/j.1471-0528.2009.02221.x. PMID 19459860. S2CID 19914146.
^ World Health Organization (2023). The selection and use of essential medicines 2023: web annex A: World Health Organization model list of essential medicines: 23rd list (2023). Geneva: World Health Organization. hdl:10665/371090. WHO/MHP/HPS/EML/2023.02.

External links

"Water for Pharmaceutical Use". Inspection Technical Guides. U.S. Food and Drug Administration. 27 August 2014.
"Guideline on the quality of water for pharmaceutical use (draft)" (PDF). 4 Committee for Medicinal Products for Human Use (CHMP). European Medicines Agency (EMA). 13 November 2018.
"Water for injection". Drug Information Portal. U.S. National Library of Medicine. 16 December 2022.

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