Acetic Acid (Monograph)

Drug class: Irrigating Solutions
VA class: IR100
Chemical name: Acetic Acid
Molecular formula: C₂H₄O₂
CAS number: 64-19-7

Medically reviewed by Drugs.com on Jan 22, 2025. Written by ASHP.

Introduction

Sterile, nonpyrogenic solution with antimicrobial and acidifying effects that is used for urologic irrigation.

Uses for Acetic Acid

Bacteriuria and Bacteremia Associated with Indwelling Catheters

Constant or intermittent irrigation of the urinary bladder to help prevent growth and proliferation of susceptible urinary pathogens (especially ammonia-forming bacteria) associated with prolonged use of an indwelling urethral catheter.

Maintaining Patency of Indwelling Catheters

Periodic irrigation of an indwelling urethral catheter to help maintain patency.

Acetic Acid Dosage and Administration

General

• Acetic acid irrigating solution contains 0.25% acetic acid; this preparation should not be confused with Acetic Acid NF, which contains 36–37% of the acid, or with Diluted Acetic Acid NF, which contains 5.7–6.3% of the acid.

Administration

Used for irrigation only; do not administer by IV injection or any other parenteral route.

Urologic Irrigation

For constant or intermittent irrigation of the urinary bladder, administer by gravity drip via a disposable administration set connected to an indwelling urethral catheter designed for continuous or intermittent 2-way flow. For periodic irrigation of an indwelling urethral catheter, may use a bulb or piston syringe to administer and aspirate solution.

Use aseptic technique to prepare and administer solution. Do not use unless solution is clear, seal is intact, and container is undamaged. Use contents promptly after opening container to minimize possibility of bacterial growth or pyrogen formation.

Use new (unused) container for each initial or repeat procedure. Use separate containers for each patient.

Discard unused portion since acetic acid irrigating solution contains no preservatives.

Rate of Administration

Continuous or intermittent irrigation: Rate will approximate urine flow rate and should be adjusted to maintain a urinary effluent pH of 4.5–5. Use nitrazine or other pH paper to monitor pH, preferably at least 4 times daily.

Dosage

Adults

Bacteriuria and Bacteremia Associated with Indwelling Catheters

Urologic Irrigation

Continuous or intermittent irrigation of urinary bladder: Approximately 500–1500 mL of 0.25% acetic acid irrigating solution every 24 hours.

Maintaining Patency of Indwelling Catheters

Urologic Irrigation

Periodic irrigation of indwelling urethral catheter: Approximately 50 mL of 0.25% acetic acid solution per irrigation; may irrigate as often as desired.

Cautions for Acetic Acid

Contraindications

• Irrigation during transurethral surgical procedures.

Warnings/Precautions

Warnings

Appropriate Use of Acetic Acid 0.25% Irrigating Solution

For urologic irrigation only.

Use in patients with urinary bladder mucosal lesions may cause lesion irritation. Systemic absorption of acetic acid via open lesions may result in systemic acidosis. (See Systemic Acidosis under Cautions.) If systemic absorption occurs, discontinue irrigation and evaluate patient for possible systemic acidosis, intravascular hemolysis, and circulatory overload; institute appropriate therapy as needed.

Major Toxicities

Systemic Acidosis

Systemic acidosis reported in patients receiving 0.25% acetic acid solution for irrigation of the urinary bladder; may occur following absorption of acetic acid via open lesions of the bladder mucosa. (See Appropriate Use of Acetic Acid 0.25% Irrigating Solution under Cautions.)

If systemic acidosis occurs, discontinue irrigation, reevaluate patient, and institute appropriate therapy.

Pain

Pain (i.e., urologic pain) reported in patients receiving 0.25% acetic acid solution for irrigation of the urinary bladder; if this occurs, discontinue irrigation, reevaluate patient, and institute appropriate therapy.

Hematuria

Hematuria reported in patients receiving 0.25% acetic acid solution for irrigation of the urinary bladder; if this occurs, discontinue irrigation, reevaluate patient, and institute appropriate therapy.

Specific Populations

Pregnancy

Category C.

Lactation

Caution advised if acetic acid 0.25% irrigating solution is used in nursing women.

Pediatric Use

Safety and efficacy not established in pediatric patients.

Geriatric Use

Insufficient experience in patients >65 years of age to determine whether geriatric patients respond differently than younger adults. Systemic absorption unlikely (unless open lesions of the bladder mucosa are present); however, increased sensitivity cannot be ruled out.

Common Adverse Effects

Systemic acidosis, pain/urologic pain, hematuria.

Acetic Acid Pharmacokinetics

Absorption

Bioavailability

Systemic absorption unlikely unless open lesions of the bladder mucosa are present. (See Appropriate Use of Acetic Acid 0.25% Irrigating Solution under Cautions.)

Stability

Storage

Irrigation

Solution for Irrigation

20–25°C (may be exposed briefly to temperatures up to 40°C). Avoid excessive heat; do not warm >66°C. Do not freeze.

Use immediately after opening; discard unused portion.

Actions

• Exerts antimicrobial action against a variety of microorganisms (especially ammonia-forming bacteria) that often gain access to the urinary bladder in patients requiring prolonged indwelling urethral catheterization. Antimicrobial activity depends on administration at sufficient rate (continuous or intermittent) to maintain effluent pH ≤5. (See Rate of Administration under Dosage and Administration.)

• Reduces formation of calcium encrustations in indwelling catheter by maintaining low urine pH.

Advice to Patients

• Importance of reporting any adverse effects (e.g., pain, hematuria) to a clinician.

• Importance of understanding that acetic acid solution is intended for urologic irrigation only.

• Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs.

• Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.

• Importance of informing patients of other important precautionary information. (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

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