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Bacteriostatic water

State of the evidence

Human evidence
No clinical trial has ever studied bacteriostatic water itself, and none would be expected — it is a vehicle, and vehicles are not the subject of efficacy trials. The human studies in this entry are studies of benzyl alcohol, the preservative, or of multiple-dose container practice, and not of this diluent as a product. They are: the 1982 gasping-syndrome case series in premature infants (PMID 7133084) and the contemporaneous CDC surveillance report of the same episode (PMID 6810084); a pharmacokinetic study in elderly women given a subcutaneous oil depot in which benzyl alcohol was an excipient at 10% (PMID 27019966); a retrospective patch-test analysis of 70,867 patients (PMID 35080274); and an HCV outbreak investigation implicating shared multidose vials (PMID 21529725). None of these tested bacteriostatic water, and the neonatal record — which drives the entire regulatory position — describes one specific exposure pattern in one specific population.
Published in
In vitro protein and peptide formulation studies dominate (interferon alpha-2a, recombinant human IL-1 receptor antagonist, alpha-chymotrypsinogen A, an IgG1 monoclonal antibody, and one peptide system); in vitro membrane and cell biology (human erythrocytes, multilamellar model vesicles, cultured cells); one documented chemical incompatibility report (ifosfamide with benzyl-alcohol-preserved bacteriostatic water); analytical method papers; human observational studies of the preservative; and reviews. There is no rodent literature in this entry and none is relevant: there is no pharmacology to model because there is no active ingredient.
Largest human study identified
Geier et al 2022 (PMID 35080274) — a retrospective analysis of 70,867 patients patch-tested with benzyl alcohol 1% in petrolatum across the German-language IVDK network between 2010 and 2019, reporting 146 positive reactions (0.21%), of which 89% were only weakly positive. It is a study of the preservative as a topical contact allergen, not of the diluent.
Regulatory status
UK: Water for Injections BP holds UK marketing authorisations and is a prescription-only medicine, as injectables generally are under the Human Medicines Regulations 2012. There is no British Pharmacopoeia or European Pharmacopoeia monograph for a benzyl-alcohol-preserved water — Bacteriostatic Water for Injection is a United States compendial article — so a bacteriostatic water sold in the UK is ordinarily a laboratory reagent rather than a licensed medicine, and under MHRA Guidance Note 8 and medicinal product by presentation it is the claim rather than the composition that decides which. EU
Anti-doping status
Neither water (CAS 7732-18-5) nor benzyl alcohol (CAS 100-51-6) appears anywhere on the WADA 2026 Prohibited List, in any class, in or out of competition. One provision nonetheless attaches to any vehicle: prohibited method M2.2, within Chemical and Physical Manipulation, prohibits intravenous infusions and/or injections of more than a total of 100 mL per 12-hour period, except those legitimately received in the course of hospital treatments, surgical procedures or clinical diagnostic investigations. M2.2 has been a Specified Method since 1 January 2021. Because the rule is expressed as a volume, a diluent counts toward it even though the diluent itself is unlisted.
Last reviewed
8 August 2026

Every line above is a statement about the published record, not an assessment of the compound. Where no human trial exists, this panel says so.

Identity
ClassReconstitution & Consumables
Also known asBacteriostatic Water for Injection USP; BWFI; bacteriostatic WFI; BAC water; preserved water for injection; water for injection with 0.9% benzyl alcohol
Molecular formulaH2O; preservative C7H8O at 0.9% w/v (9 mg/mL), approximately 83 mmol/L
Molecular weight18.015 g/mol (water); 108.14 g/mol (benzyl alcohol)
CAS number7732-18-5 (water); 100-51-6 (benzyl alcohol, present as preservative at 0.9% w/v)

Bacteriostatic water — identity, handling and published literature

Bacteriostatic water is a reconstitution diluent rather than an active compound: water for injection to which benzyl alcohol has been added at 0.9% w/v as a bacteriostatic preservative, presented in a multiple-dose container from which repeated withdrawals may be taken.

Presentation and physical properties

The article is a clear, colourless, essentially odourless-to-faintly-aromatic aqueous solution. Its two constituents are water (CAS 7732-18-5, H2O, relative molecular mass 18.015) and benzyl alcohol (CAS 100-51-6, C7H8O, relative molecular mass 108.14), an aromatic primary alcohol with a PubChem XLogP of 1.1. There is no peptide sequence, no active moiety and no assay of potency, because there is no active ingredient; the identity fields for this entry describe the vehicle and its preservative and nothing else.

At the conventional 0.9% w/v the solution contains 9 mg of benzyl alcohol per millilitre, which is a molar concentration of approximately 83 mmol/L (9 ÷ 108.14). A second presentation exists at 1.1% w/v, that is 11 mg/mL, typically in glass. The US compendial article Bacteriostatic Water for Injection USP is specified with a pH of 5.7 within a permitted range of 4.5 to 7.0, and the USP packaging and storage requirement restricts it to single-dose or multiple-dose glass or plastic containers of not larger than 30 mL. The NovoVita presentation is a 10 ml vial.

The solution is hypotonic with respect to blood; the approved US labelling for the pharmaceutical article carries the warning that intravenous administration without a solute may result in haemolysis, together with the statements NOT FOR USE IN NEONATES and FOR DRUG DILUENT USE ONLY, and instructs that preparations containing benzyl alcohol are not to be used for fluid replacement or in epidural or spinal anaesthesia.

Reconstitution arithmetic

Because the diluent contributes no solute, the arithmetic here is the trivial part and the choice of diluent is the substantive part. For a lyophilised solid of mass m dissolved in a diluent volume V, the resulting concentration is C = m ÷ V. The preservative concentration is unaffected by the volume added: it remains 9 mg/mL of benzyl alcohol throughout, because the benzyl alcohol travels with the water. What changes with volume is the total quantity of benzyl alcohol introduced into the vial.

Arithmetic at three diluent volumes, at 0.9% w/v benzyl alcohol
Diluent addedBenzyl alcohol introducedBenzyl alcohol concentration5 mg solute10 mg solute20 mg solute
1 mL9 mg9 mg/mL5.00 mg/mL10.00 mg/mL20.00 mg/mL
2 mL18 mg9 mg/mL2.50 mg/mL5.00 mg/mL10.00 mg/mL
3 mL27 mg9 mg/mL1.67 mg/mL3.33 mg/mL6.67 mg/mL

Two arithmetic caveats. The solid displaces a small volume of its own, so the final volume slightly exceeds the diluent added and the true concentration is marginally below the figure in the table; at milligram quantities this sits below the graduation resolution of a 1 mL syringe. And bulking agents such as mannitol contribute to the mass of the cake but not to the mass of the substance of interest, so a nominal vial mass is not necessarily the mass entering the calculation.

Choosing between a preserved and an unpreserved diluent

The published record establishes several distinctions that bear on that choice.

Compendial framing. The European Pharmacopoeia monograph on parenteral preparations (0520) states that multidose aqueous injections contain a suitable antimicrobial preservative at an appropriate concentration except where the preparation itself has adequate antimicrobial properties. The same monograph withholds a preservative in two circumstances: where the volume to be injected in a single dose exceeds 15 mL, unless otherwise justified; and where the route is one for which a preservative is not medically acceptable, specifically intracisternal, epidural, intrathecal, any route giving access to the cerebrospinal fluid, and intra- or retro-ocular routes.

Protein and peptide compatibility. Benzyl alcohol is the preservative most widely used in multidose protein formulations and is also the one most extensively documented as destabilising them — the mechanism is set out in the literature section below. Reported effects vary by molecule, so compatibility is a per-substance question rather than a general one [5][6][7][8][9][10][11].

Chemical incompatibility with the diluted substance. Incompatibility need not involve a protein at all. Behme and colleagues documented a direct incompatibility between ifosfamide and benzyl-alcohol-preserved bacteriostatic water for injection [12], which is the reason a preserved diluent cannot be treated as interchangeable with water for injection on the assumption that water is water.

Preservative efficacy is not independent of the solute. Heljo and colleagues reported that preservative molecules adsorb onto peptide oligomers and that higher peptide concentrations reduced measured antimicrobial effectiveness [11]. The preservative and the dissolved substance therefore act on each other in both directions.

Storage and stability

Unopened containers of the pharmaceutical article are labelled for storage at controlled room temperature and are not intended to be frozen. Once a container has been entered, the governing figure is a conventional one.

Where the 28-day figure actually comes from

The 28-day convention is a property of the preservative system and the container closure. It is not derived from, and says nothing about, the stability of any substance dissolved in the diluent.

USP General Chapter <797> assigns a beyond-use date of 28 days after a multiple-dose container is first entered or opened, unless the manufacturer specifies otherwise, and cross-references General Chapter <51>, Antimicrobial Effectiveness Testing — the chapter that establishes whether a preservative system can suppress an introduced microbial challenge over time. US Centers for Disease Control guidance on injection safety states the same 28-day limit for multi-dose vials, again subject to any different manufacturer specification. In both cases the number describes how long the preservative can be relied upon to remain effective in an entered container, and nothing more.

Three consequences follow. First, a peptide or protein dissolved in bacteriostatic water has its own, entirely separate degradation timescale, which may be shorter or longer than 28 days and is established only by stability-indicating assay of that substance. Second, benzyl alcohol is volatile and lipophilic, so preservative content in an entered vial is not fixed: partition into headspace and into elastomeric closures is a recognised formulation concern, which is one reason the figure is bounded rather than open-ended. Third, the preservative is bacteriostatic — it inhibits replication rather than sterilising — and it has no action on viruses at all. Mattner and Gastmeier’s prevalence survey of 227 multiple-dose vials in a German tertiary hospital found a 0.9% contamination rate, with Staphylococcus epidermidis recovered from one vial and one spike, and also recorded that only about half the vials carried an opening date [20]. Moore and colleagues traced hepatitis C transmission in an outpatient cardiology clinic to unsafe injection practice involving shared multidose vials, a route a bacteriostatic preservative cannot close [21].

Analytical identity

Two independent analytical questions arise: whether the water meets the specification for water for injection, and whether the stated quantity of preservative is present.

For the water, compendial identity rests on physicochemical rather than spectroscopic criteria. The European Pharmacopoeia monograph for Water for Injections (0169) specifies conductivity, total organic carbon at not more than 0.5 mg/L, and bacterial endotoxins at less than 0.25 IU/mL, alongside sterility for the sterilised article. There is no meaningful identity spectrum for water in the sense that a peptide has one.

For the preservative, benzyl alcohol carries an aromatic chromophore that plain water for injection does not, so its presence is readily distinguished by ultraviolet absorbance, and it is quantified by gas chromatography or reversed-phase high-performance liquid chromatography. Validated reversed-phase HPLC methods for benzyl alcohol and its metabolite are published — Tan and colleagues described one for plasma [4], and Kalicharan and colleagues validated a serum assay measuring benzyl alcohol together with benzoic acid and hippuric acid [3]. The same separation principle applies straightforwardly to the neat diluent, where the matrix is far simpler.

Practically, this means bacteriostatic water and sterile water for injection are not distinguishable by appearance and are trivially distinguishable by assay. A container whose contents cannot be confirmed as preserved should not be assumed to be.

What the published literature investigated

Effects of benzyl alcohol on protein and peptide formulations

This is the largest body of work and it is almost entirely in vitro. Zhang and colleagues reported that benzyl alcohol accelerated aggregation and precipitation of recombinant human interleukin-1 receptor antagonist in aqueous solution, and characterised the mechanism as hydrophobic binding producing a minor perturbation of tertiary structure without alteration of secondary structure, shifting the population toward partially unfolded, aggregation-competent species; they also reported that sucrose partially counteracted the effect [5]. Roy and colleagues extended the work to reconstituted lyophilised formulations of the same protein [6].

Bis and Mallela reported that four antimicrobial preservatives induced aggregation of interferon α-2a in a fixed rank order — m-cresol > phenol > benzyl alcohol > phenoxyethanol — and that the same order had previously been observed with cytochrome c, from which they argued the general mechanism may be independent of the protein [7]. A companion study using nuclear magnetic resonance, fluorescence and hydrogen exchange concluded that benzyl alcohol induced aggregation of interferon α-2a by partial rather than global unfolding, localising the vulnerability to the AB-loop region and correlating it with computationally predicted aggregation hot spots [8].

Rodríguez-Martínez and colleagues reported that 0.9% benzyl alcohol produced substantial aggregation of α-chymotrypsinogen A within 24 hours, and that attaching two or five molecules of 5000 Da polyethylene glycol prevented it completely while 700 Da PEG did not, attributing the protection to shielding of exposed hydrophobic surface rather than to structural stabilisation [9]. Arora and colleagues compared m-cresol, phenol, phenoxyethanol and benzyl alcohol against an IgG1 monoclonal antibody using differential scanning calorimetry, size-exclusion chromatography over 28 days at 50 °C and hydrogen exchange mass spectrometry, and reported that the destabilising effect correlated with preservative hydrophobicity and with increased flexibility in the CH2 domain, residues 237–254 [10].

Heljo and colleagues examined benzyl alcohol, phenol and m-cresol against a peptide rather than a protein, reporting that m-cresol increased the hydrodynamic radius and molar mass of peptide oligomers more markedly than the other two, and that preservative adsorption onto peptide oligomers accompanied reduced antimicrobial efficacy [11].

Chemical incompatibility outside the protein case

Behme and colleagues documented an incompatibility of ifosfamide with benzyl-alcohol-preserved bacteriostatic water for injection [12]. The PubMed record carries no abstract, so the entry establishes that the incompatibility was reported and identified rather than the analytical detail of it.

Membrane and cell-biology effects of benzyl alcohol

Chabanel and colleagues studied human red blood cells by fluorescence anisotropy and micropipette aspiration and reported that benzyl alcohol up to 50 mM affected primarily the inner membrane leaflet with progressive stomatocytic shape change, that higher concentrations affected both leaflets, and that increases in membrane fluidity were not accompanied by changes in membrane viscoelasticity [13]. Maula and colleagues, working with multilamellar lipid vesicles, reported that cholesterol-enriched domains resisted benzyl-alcohol-induced fluidisation better than pure gel-phase domains, and that ceramide- and galactosylceramide-containing gel phases were the most resistant of those tested [14]. Simm and colleagues reported that benzyl alcohol caused a reversible fragmentation of the Golgi apparatus and inhibited membrane trafficking between endosomes and the trans-Golgi network in cultured cells [15].

These studies are the mechanistic basis for describing benzyl alcohol as a membrane-active agent, which is also how its bacteriostatic action is understood. The concentrations used are experimental parameters and are not comparable to any exposure figure.

Human toxicology and pharmacokinetics of the preservative

The human record for benzyl alcohol is dominated by a single episode. Gershanik and colleagues described the gasping syndrome in premature infants in a neonatal intensive care unit, associating a syndrome of neurological deterioration, metabolic acidosis, gasping respirations, hepatic and renal failure and cardiovascular collapse with benzyl alcohol exposure, principally from benzyl-alcohol-preserved flush solutions [1]. The US Centers for Disease Control published a contemporaneous surveillance report of neonatal deaths associated with benzyl alcohol use [2]. Both are 1982 and both concern a neonatal population; the regulatory consequences are described in the regulatory section below.

Kalicharan and colleagues conducted a human pharmacokinetic study in elderly women given a subcutaneous oil depot containing 10% benzyl alcohol alongside nandrolone decanoate and cholecalciferol, following benzyl alcohol and its metabolites in serum over 35 days; they reported that benzyl alcohol appeared in serum immediately after injection and was depleted from the depot within 52 hours [3]. The metabolic route this study tracks — oxidation to benzoic acid and glycine conjugation to hippuric acid — is the one described in the Cosmetic Ingredient Review safety assessment of benzyl alcohol, benzoic acid and sodium benzoate [19].

Contact sensitisation

Geier and colleagues analysed 70,867 patients patch-tested with benzyl alcohol 1% in petrolatum in the German-language IVDK network between 2010 and 2019 and reported 146 positive reactions, 0.21%, of which 89% were only weakly positive; doubtful and irritant reactions significantly outnumbered positives. Sensitisation was concentrated in patients with stasis dermatitis and those over 40, and the authors concluded benzyl alcohol is a rare sensitiser and questioned its regulatory designation as a skin sensitiser [16]. Curry and Warshaw described benzyl alcohol as a weak sensitiser found widely in plants, foods, cosmetics and medications, and reviewed both delayed contact and immediate reactions [18]. The American Contact Dermatitis Society named benzyl alcohol Allergen of the Year for 2026, and the accompanying review by Le and Wu sets out the argument for wider inclusion in patch-test series on the grounds of under-recognition rather than high prevalence [17].

Microbiology of multiple-dose containers

Covered above under storage: Mattner and Gastmeier’s 227-vial prevalence study [20] and Moore and colleagues’ outbreak investigation [21].

Evidence gaps and limitations

No controlled human trial of bacteriostatic water as an intervention exists, and none would be expected. It is a vehicle, and vehicles are not the subject of efficacy trials. Every human study in the reference list concerns benzyl alcohol as a substance — its toxicity in neonates, its pharmacokinetics from an oil depot, its sensitisation frequency on patch testing — and not this preparation as a product. The neonatal literature that shapes the entire regulatory position is two publications from 1982 describing a specific and now-avoided exposure pattern; it does not characterise other exposure patterns and was never designed to.

The formulation literature has a sharper limitation than its volume suggests. It is overwhelmingly concerned with large recombinant proteins — interferon α-2a, interleukin-1 receptor antagonist, chymotrypsinogen, an IgG1 monoclonal antibody. Aggregation in those systems proceeds through partial unfolding of a folded tertiary structure. A short synthetic peptide with little or no tertiary structure is not the same physical system, and the rank orders and mechanisms reported for proteins cannot be transferred to it on the strength of those papers. Heljo and colleagues [11] is one of very few studies to address a peptide directly, and one study is not a literature.

There is no published stability data for the great majority of research peptides in 0.9% benzyl alcohol water, at any temperature, over any interval. The 28-day figure has no peptide-stability evidence behind it whatsoever — it is an antimicrobial-effectiveness convention that has been widely and wrongly repeated as though it described chemical stability of the dissolved substance.

No human study has compared a preserved with an unpreserved diluent for any outcome. The contact-sensitisation data derive from patch testing of topical exposure, and their relevance to a parenteral vehicle is not established by those studies. The membrane and cell-biology findings [13][14][15] were obtained at experimental concentrations chosen to produce a measurable effect, and no relationship between those concentrations and any real exposure is established by them.

Regulatory and standards position

United Kingdom

Water for Injections BP holds UK marketing authorisations and is a prescription-only medicine, as products administered by injection generally are under the Human Medicines Regulations 2012. There is no British Pharmacopoeia or European Pharmacopoeia monograph for a benzyl-alcohol-preserved water: Bacteriostatic Water for Injection is a United States compendial article, and the multi-dose preserved diluent is a US practice pattern rather than a UK-licensed one. A bacteriostatic water sold in the UK is therefore, in the ordinary case, a laboratory reagent and not a licensed medicine.

What determines the position is presentation, not composition. Under MHRA Guidance Note 8 and the doctrine of medicinal product by presentation, a claim is what makes something a medicine in law. A diluent offered as a laboratory reagent occupies one legal category; the identical liquid offered with statements about preparing an injectable for human use occupies another.

European Union

The European Commission guideline on excipients in the labelling and package leaflet of medicinal products for human use, and its Annex maintained with the EMA, require specific benzyl alcohol warnings on parenteral products: it must not be given to premature babies or neonates, and a warning is required in relation to exposure exceeding 90 mg/kg/day in infants and children, on account of the risk of fatal toxic reactions. European Pharmacopoeia monograph 0520 governs when a preservative may be present in a parenteral preparation at all, as set out in the reconstitution section above.

Benzyl alcohol as a substance carries a harmonised classification in Annex VI to Regulation (EC) No 1272/2008 (CLP) of Acute Tox. 4, H302 (harmful if swallowed) and Acute Tox. 4, H332 (harmful if inhaled); Eye Irrit. 2, H319 appears widely in registrant self-classification. The classification attaches to the neat substance, and a 0.9% w/v aqueous solution sits far below the concentrations at which those endpoints are triggered for a mixture.

United States

Bacteriostatic Water for Injection USP is an approved, prescription-only drug product with a USP monograph. Its labelling is restrictive: NOT FOR USE IN NEONATES, FOR DRUG DILUENT USE ONLY, not for fluid replacement, not for epidural or spinal anaesthesia, and a warning that intravenous administration without a solute may result in haemolysis. USP packaging and storage requirements limit containers to not larger than 30 mL.

Controlled-drug status

None. Neither water nor benzyl alcohol is scheduled under the Misuse of Drugs Act 1971 or the Misuse of Drugs Regulations 2001, and neither is a controlled substance under the US Controlled Substances Act.

WADA

Neither water nor benzyl alcohol appears anywhere on the WADA 2026 Prohibited List, in any class, in or out of competition. One provision nonetheless bears directly on a diluent: prohibited method M2.2, within Chemical and Physical Manipulation, prohibits intravenous infusions and/or injections of more than a total of 100 mL per 12-hour period, except those legitimately received in the course of hospital treatments, surgical procedures or clinical diagnostic investigations. M2.2 has been a Specified Method since 1 January 2021. Because the limit is expressed as a volume, the vehicle counts toward it regardless of what is dissolved in it — a substance that is itself unlisted can still be part of a prohibited method.

Documented enforcement

Bacteriostatic water has been the direct subject of published enforcement, which is unusual for a diluent. On 31 March 2026 the US Food and Drug Administration issued warning letters to a number of online peptide vendors — among them Gram Peptides, Prime Sciences, PekCura Labs and Lovega LLC trading as Pink Pony Peptides — in which bacteriostatic water offered for sale alongside peptide products was itself treated as an unapproved new drug under section 505(a) of the Federal Food, Drug, and Cosmetic Act. The reasoning was that offering the diluent for sale together with peptides requiring reconstitution evidenced an intended use in combination for injection. That is the clearest published statement of the principle that a diluent’s regulatory status can be set by the company it keeps rather than by anything in the bottle.

Laboratory handling and safety

Treat the container as a multiple-dose container in the compendial sense. Disinfect the septum before every entry and use a fresh sterile needle and syringe each time; the preservative suppresses the growth of organisms introduced by an imperfect entry, it does not prevent their introduction, and it has no action on viruses [21]. Date the container at first entry — Mattner and Gastmeier found that only about half of the vials they surveyed carried an opening date, which makes any beyond-use convention unenforceable in practice [20]. Do not pool the contents of containers and do not top one up from another.

Benzyl alcohol is volatile; keep containers closed, and do not decant into unsealed vessels where preservative content will fall unrecorded. Store per the labelled conditions and do not freeze. The neat substance carries CLP Annex VI classifications of Acute Tox. 4 by oral and inhalation routes; ordinary laboratory practice for an aqueous reagent — eye protection, gloves, no mouth pipetting — is appropriate for the diluted article.

Before using a preserved diluent with any substance, establish compatibility for that substance specifically. The literature above records destabilisation of several proteins [5][6][7][8][9][10] and a direct chemical incompatibility with at least one small molecule [12]. Where a preserved diluent is unsuitable, or where European Pharmacopoeia monograph 0520 withholds a preservative for the route concerned, water for injection without a preservative is the alternative, at the cost of the multiple-entry window the preservative provides.

Dispose of the entered container at the applicable beyond-use point rather than on inspection: a solution contaminated at the levels these studies describe is visually indistinguishable from a clean one.

References

  1. Gershanik J, Boecler B, Ensley H, McCloskey S, George W. The gasping syndrome and benzyl alcohol poisoning. New England Journal of Medicine 1982;307(22):1384–8. Human case series. PMID 7133084
  2. Centers for Disease Control. Neonatal deaths associated with use of benzyl alcohol — United States. MMWR Morbidity and Mortality Weekly Report 1982;31(22):290–1. Human surveillance report. PMID 6810084
  3. Kalicharan R, El Amrani M, Schot P, Vromans H. Pharmacokinetics in elderly women of benzyl alcohol from an oil depot. Journal of Pharmaceutical Sciences 2016;105(4):1519–25. Human pharmacokinetic study. PMID 27019966
  4. Tan HS, Manning MA, Hahn MK, Tan HG, Kotagal UR. Determination of benzyl alcohol and its metabolite in plasma by reversed-phase high-performance liquid chromatography. Journal of Chromatography 1991;568(1):145–55. Analytical method development. PMID 1770092
  5. Zhang Y, Roy S, Jones LS, Krishnan S, Kerwin BA, Chang BS, Manning MC, Randolph TW, Carpenter JF. Mechanism for benzyl alcohol-induced aggregation of recombinant human interleukin-1 receptor antagonist in aqueous solution. Journal of Pharmaceutical Sciences 2004;93(12):3076–89. In vitro protein formulation study. PMID 15514986
  6. Roy S, Jung R, Kerwin BA, Randolph TW, Carpenter JF. Effects of benzyl alcohol on aggregation of recombinant human interleukin-1-receptor antagonist in reconstituted lyophilized formulations. Journal of Pharmaceutical Sciences 2005;94(2):382–96. In vitro protein formulation study. PMID 15614819
  7. Bis RL, Mallela KMG. Antimicrobial preservatives induce aggregation of interferon alpha-2a: the order in which preservatives induce protein aggregation is independent of the protein. International Journal of Pharmaceutics 2014;472(1–2):356–61. In vitro protein formulation study. PMID 24974985
  8. Bis RL, Singh SM, Cabello-Villegas J, Mallela KMG. Role of benzyl alcohol in the unfolding and aggregation of interferon α-2a. Journal of Pharmaceutical Sciences 2015;104(2):407–15. In vitro biophysical study. PMID 25100180
  9. Rodríguez-Martínez JA, Rivera-Rivera I, Griebenow K. Prevention of benzyl alcohol-induced aggregation of chymotrypsinogen by PEGylation. Journal of Pharmacy and Pharmacology 2011;63(6):800–5. In vitro protein formulation study. PMID 21585378
  10. Arora J, Joshi SB, Middaugh CR, Weis DD, Volkin DB. Correlating the effects of antimicrobial preservatives on conformational stability, aggregation propensity, and backbone flexibility of an IgG1 mAb. Journal of Pharmaceutical Sciences 2017;106(6):1508–18. In vitro protein formulation study. PMID 28212986
  11. Heljo P, Ross A, Zarraga IE, Pappenberger A, Mahler HC. Interactions between peptide and preservatives: effects on peptide self-interactions and antimicrobial efficiency in aqueous multi-dose formulations. Pharmaceutical Research 2015;32(10):3201–12. In vitro peptide formulation study. PMID 25893328
  12. Behme RJ, Brooke D, Kensler TT, Scott JA. Incompatibility of ifosfamide with benzyl-alcohol-preserved bacteriostatic water for injection. American Journal of Hospital Pharmacy 1988;45(3):627–8. In vitro compatibility report. PMID 3369469
  13. Chabanel A, Abbott RE, Chien S, Schachter D. Effects of benzyl alcohol on erythrocyte shape, membrane hemileaflet fluidity and membrane viscoelasticity. Biochimica et Biophysica Acta 1985;816(1):142–52. In vitro study, human erythrocytes. PMID 4005233
  14. Maula T, Westerlund B, Slotte JP. Differential ability of cholesterol-enriched and gel phase domains to resist benzyl alcohol-induced fluidization in multilamellar lipid vesicles. Biochimica et Biophysica Acta 2009;1788(11):2454–61. In vitro model membrane study. PMID 19766094
  15. Simm R, Kvalvaag AS, van Deurs B, Lindbäck T, Sandvig K. Benzyl alcohol induces a reversible fragmentation of the Golgi apparatus and inhibits membrane trafficking between endosomes and the trans-Golgi network. Experimental Cell Research 2017;357(1):67–78. In vitro cell biology study. PMID 28450044
  16. Geier J, Ballmer-Weber B, Buhl T, Rieker-Schwienbacher J, Mahler V, Dickel H, Schubert S. Is benzyl alcohol a significant contact sensitizer? Journal of the European Academy of Dermatology and Venereology 2022;36(6):866–72. Human retrospective patch-test analysis, 70,867 patients. PMID 35080274
  17. Le NT, Wu PA. Benzyl alcohol: Allergen of the Year 2026. Dermatitis 2026;37(1):4–12. Review. PMID 41649135
  18. Curry EJ, Warshaw EM. Benzyl alcohol allergy: importance of patch testing with personal products. Dermatitis 2005;16(4):203–8. Review and case report. PMID 16536335
  19. Nair B. Final report on the safety assessment of benzyl alcohol, benzoic acid, and sodium benzoate. International Journal of Toxicology 2001;20(Suppl 3):23–50. Review. PMID 11766131
  20. Mattner F, Gastmeier P. Bacterial contamination of multiple-dose vials: a prevalence study. American Journal of Infection Control 2004;32(1):12–6. Prevalence study, 227 vials cultured. PMID 14755229
  21. Moore ZS, Schaefer MK, Hoffmann KK, et al. Transmission of hepatitis C virus during myocardial perfusion imaging in an outpatient clinic. American Journal of Cardiology 2011;108(1):126–32. Human outbreak investigation. PMID 21529725

Research use only

This entry is a technical and literature record compiled for laboratory reference. Bacteriostatic water supplied by NovoVita is a laboratory reagent supplied for research use only. It is not a medicinal product, it holds no UK marketing authorisation, and it is not authorised for human or veterinary use, for administration to any person or animal, or for any household or food application. Nothing above is a statement that any substance described does anything, and nothing above is guidance on preparing, administering or using any substance in a person or an animal. The literature is reported as literature: a statement that a study measured a particular effect is a statement about that study, not about this product.

Published literature over time

19822026
in vitroanimalhuman trialreviewevery verified dot opens its source
  1. 1982human trialGershanik et al, N Engl J Med — gasping syndrome case series in premature infants exposed to benzyl-alcohol-preserved flush solutionsPMID 7133084
  2. 1982human trialCDC, MMWR — surveillance report of neonatal deaths associated with benzyl alcohol usePMID 6810084
  3. 1985in vitroChabanel et al, BBA — benzyl alcohol effects on human erythrocyte shape, hemileaflet fluidity and membrane viscoelasticityPMID 4005233
  4. 1988in vitroBehme et al, Am J Hosp Pharm — documented incompatibility of ifosfamide with benzyl-alcohol-preserved bacteriostatic water for injectionPMID 3369469
  5. 1991in vitroTan et al, J Chromatogr — validated reversed-phase HPLC assay for benzyl alcohol and its metabolite in plasmaPMID 1770092
  6. 2001reviewNair, Int J Toxicol — CIR safety assessment of benzyl alcohol, benzoic acid and sodium benzoate, including the benzoic acid/hippuric acid metabolic routePMID 11766131
  7. 2004in vitroZhang et al, J Pharm Sci — mechanism of benzyl alcohol-induced aggregation of recombinant human IL-1 receptor antagonist; partial tertiary perturbation, sucrose partially protectivePMID 15514986
  8. 2004in vitroMattner & Gastmeier, Am J Infect Control — prevalence study, 227 multiple-dose vials cultured; 0.9% contaminated, half undatedPMID 14755229
  9. 2005in vitroRoy et al, J Pharm Sci — benzyl alcohol effects on aggregation of rhIL-1ra in reconstituted lyophilised formulationsPMID 15614819
  10. 2005reviewCurry & Warshaw, Dermatitis — benzyl alcohol allergy review and case reportPMID 16536335
  11. 2009in vitroMaula et al, BBA — resistance of cholesterol-enriched and gel-phase domains to benzyl alcohol-induced fluidisation in model vesiclesPMID 19766094
  12. 2011in vitroRodriguez-Martinez et al, J Pharm Pharmacol — 0.9% benzyl alcohol aggregated chymotrypsinogen within 24 h; 5000 Da PEGylation prevented it, 700 Da did notPMID 21585378
  13. 2011human trialMoore et al, Am J Cardiol — HCV transmission outbreak investigation implicating shared multidose vials and reused needlesPMID 21529725
  14. 2014in vitroBis & Mallela, Int J Pharm — preservative-induced aggregation of interferon alpha-2a in fixed rank order m-cresol > phenol > benzyl alcohol > phenoxyethanolPMID 24974985
  15. 2015in vitroBis et al, J Pharm Sci — benzyl alcohol induces interferon alpha-2a aggregation via partial rather than global unfolding, localised to the AB-loopPMID 25100180
  16. 2015in vitroHeljo et al, Pharm Res — peptide/preservative interaction; preservative adsorption onto peptide oligomers and reduced antimicrobial efficiencyPMID 25893328
  17. 2016human trialKalicharan et al, J Pharm Sci — pharmacokinetics of benzyl alcohol and its metabolites in elderly women given a 10% benzyl alcohol oil depotPMID 27019966
  18. 2017in vitroArora et al, J Pharm Sci — preservative destabilisation of an IgG1 mAb correlated with hydrophobicity and CH2 backbone flexibilityPMID 28212986
  19. 2017in vitroSimm et al, Exp Cell Res — reversible Golgi fragmentation and inhibited endosome-to-TGN trafficking in cultured cellsPMID 28450044
  20. 2022human trialGeier et al, JEADV — IVDK retrospective, 70,867 patients patch-tested; 0.21% positive, 89% weakly soPMID 35080274
  21. 2026reviewLe & Wu, Dermatitis — benzyl alcohol named ACDS Allergen of the Year 2026; review of under-recognitionPMID 41649135

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