Bacteriostatic Water for Injections contains benzyl alcohol (see section 2). The preservative benzyl alcohol may cause hypersensitivity reactions.
Intravenous administration of benzyl alcohol has been associated with serious adverse events, and death in paediatric patients including neonates (“ gasping syndrome” ). Although normal therapeutic doses of this product ordinarily deliver amounts of benzyl alcohol that are substantially lower than those reported in association with the “ gasping syndrome” , the minimum amount of benzyl alcohol at which toxicity may occur is not known. Benzyl alcohol containing formulations should only be used in neonates if it is necessary and if there are no alternatives possible. Premature and low-birth weight neonates may be more likely to develop toxicity. Benzyl alcohol containing formulations should not be used for more than 1 week in children under 3 years of age unless necessary. If use of a benzyl alcohol-containing formulation of Bacteriostatic Water for Injections is necessary, it is important to consider the combined daily metabolic load of benzyl alcohol from all sources, especially in patients with liver or kidney impairment, as well as in pregnant or breast-feeding women, because of the risk of accumulation and toxicity (metabolic acidosis).