Medication Guide App

Iodine (Topical)


VA CLASSIFICATION
Primary: DE101

Some commonly used names are
iodine tincture {02} {04} {16} and strong iodine tincture . {04} {16}
Note: For a listing of dosage forms and brand names by country availability, see Dosage Forms section(s).

Not commercially available in Canada.



Category:


Antibacterial (topical){01}{03}{05}{06}{08}{09}{10}{11}{13}

Indications

Accepted

Skin infections, bacterial, minor (prophylaxis and treatment)—Iodine is indicated as an antiseptic and disinfectant in the topical prophylaxis and treatment of superficial skin infections caused by susceptible gram-positive and gram-negative bacteria in minor abrasions, burns, or cuts. It is the most effective disinfectant for intact skin and is used to disinfect the skin preoperatively or prior to obtaining blood cultures by venipuncture. {01} {03} {05} {07} {08} {09} {10} {11} {13}


Pharmacology/Pharmacokinetics

Physicochemical characteristics:
Molecular weight—
    126.9 {01} {23}

Mechanism of action/Effect:

Although the mechanism of action of topical iodine is not fully understood, it is thought that the medication's antimicrobial effects may be due to the presence of the diatomic elemental form of iodine (free iodine). It is believed that iodine precipitates the proteins of the microorganisms by forming salts via direct halogenation. Approximately 90% of the iodine absorbed by bacterial cells reappears as the iodide, thus confirming oxidative interaction as the major bactericidal mechanism of topical iodine. {01} {06} {13}

Antimicrobial activity is significantly affected by pH and is greater under acidic conditions.

Solutions of iodine usually contain potassium or sodium iodide to enhance solubility of iodine through the formation of polyiodide ion. {26}


Other actions/effects:

Iodine also possesses fungicidal, protozoacidal (e.g., trichomonicidal), cysticidal, virucidal, {01} {08} {09} {13} and some sporocidal activities. {10}

Absorption:

Slightly absorbed as iodide when applied topically to intact skin. Absorption by damaged skin and mucous membranes may be extensive and may lead to 10 4-fold increases in serum iodine concentrations compared to normal. {01} {26}

Distribution:

May be absorbed by the thyroid gland and may appear in saliva, sweat, and milk. {01}

Biotransformation:

Undergoes minimal metabolism and is converted to the iodide. {01}

Elimination:
    Excreted unchanged in the urine. {01} {18} {26}


Precautions to Consider

Pregnancy/Reproduction

Pregnancy—
Iodine crosses the placenta; use is not recommended during pregnancy because of possible absorption and adverse effects on the fetus such as hypothyroidism and goiter. {01} {14} {19} {20}


Labor and delivery—

Use may result in significant absorption both in the mother and the fetus; transient hypothyroidism has been found in infants exposed to topical iodine following vaginal or perineal use before delivery. {19} {21} {22}

Breast-feeding

Iodine applied topically may be distributed into breast milk; use is not recommended for nursing mothers because it may result in iodide overload and transient hypothyroidism in the nursing infants. {01} {14} {18} {19} {20} {21}

Pediatrics

Use is not recommended for neonates because of their potential for increased absorption; topically applied iodine may result in skin hypersensitivity, iodide overload, and transient hypothyroidism. {01} {14} {18} {19} {22} {26}


Geriatrics


Appropriate studies on the relationship of age to the effects of topical iodine have not been performed in the geriatric population. However, no geriatrics-specific problems have been documented to date. {01}


Dental

Iodine solution may be applied to the oral mucosa, teeth, or rubber dams for antibacterial purposes. However, it may cause irritation to the mucosa, resulting in a sensation of heat or itching, or blister formation. Iodine may also reversibly stain the oral mucosa, teeth, rubber dams, and acrylic, silicate, and porcelain restorations. These stains can be removed with alcohol. {15} {17}

Medical considerations/Contraindications
The medical considerations/contraindications included have been selected on the basis of their potential clinical significance (reasons given in parentheses where appropriate)— not necessarily inclusive (» = major clinical significance).


Risk-benefit should be considered when the following medical problems exist
» Animal bites or
» Burns, severe or extensive or
» Puncture wounds, deep    (risk of adverse effects associated with increased absorption and tissue irritation {01} {02} {06} {09} {13})


Hypersensitivity to iodine{01}{07}{08}{09}{10}{14}


Side/Adverse Effects
The following side/adverse effects have been selected on the basis of their potential clinical significance (possible signs and symptoms in parentheses where appropriate)—not necessarily inclusive:

Those indicating need for medical attention
Incidence rare
    
Dermatitis (blistering, crusting, irritation, itching, or reddening of skin){01}{02}{07}{10}{25}

Symptoms of overdose (when ingested)
    
Abdominal pain
    
anuria (not passing urine)
    
diarrhea
    
excessive thirst
    
fever
    
nausea
    
vomiting{01}{25}





Patient Consultation
As an aid to patient consultation, refer to Advice for the Patient, Iodine (Topical).

In providing consultation, consider emphasizing the following selected information (» = major clinical significance):

Before using this medication
»   Conditions affecting use, especially:
Hypersensitivity to iodine {01} {07} {08} {09} {10}

Pregnancy—May cause thyroid problems in the newborn infant {01} {14} {19} {20}





Breast-feeding—May cause thyroid problems in nursing babies





Use in children—May cause skin and thyroid problems in infants {01} {14} {18} {19} {22}

Other medical problems, especially animal bites, deep wounds, or serious burns

Proper use of this medication
Using only as directed

» Not swallowing medication

» Keeping medication away from the eyes; washing medication away with water if it accidentally gets in the eyes

» Not using on deep, puncture wounds, animal bites or serious burns

» Not using a tight dressing or bandage over the wound on which topical iodine was applied

» Proper dosing
Using medication for full time of treatment
Missed dose: Applying as soon as possible; not applying if almost time for next dose

» Proper storage

Precautions while using this medication
Checking with doctor if skin problem becomes worse, or if constant irritation develops

May stain skin and clothing; removing stain on skin with alcohol; {08} {09} removing stain on clothing by washing and rinsing in dilute ammonia or with soap and water


Side/adverse effects
Blistering, crusting, irritation, itching, or reddening of skin {01} {02} {07} {10} {25}


General Dosing Information
Topical iodine should not be used on wild or domestic animal bites. Instead, a physician should be consulted immediately for proper care. {02}

Topical iodine should not be used on deep or puncture wounds, or serious burns, since these uses may increase absorption and tissue irritation. {02}

Since iodine may cause burns on occluded skin, wounds treated with topical iodine should not be covered with a tight dressing or bandage. {02}

For skin disinfection prior to medical procedures, such as venipuncture, lumbar puncture, or thoracentesis, topical iodine should be rubbed into the skin, working from the center of the area to be disinfected to the periphery in a concentric fashion. After application, the solution should be allowed to dry for at least 2 minutes (the amount of time needed for iodine to achieve its full effect) and then washed off with 70% alcohol to prevent any possibility of skin damage. {03} {09}

For treatment of adverse effects and/or overdose
Recommended treatment consists of the following:

   • For severe skin reaction—Topical iodine should be removed promptly with 70% alcohol, {08} {09} or the skin washed with large amounts of water for 15 minutes. {16}
   • For accidental ingestion—If the patient is conscious, milk may be given orally every 15 minutes to relieve gastric irritation; in addition, a starch solution, prepared by adding 15 mg of cornstarch or flour to 500 mL of water, may be administered to absorb the remaining iodine. Emesis and lavage should not be performed in the presence of esophageal injury. {25} {26}
   • Using other supportive measures to maintain vital functions, including administering oxygen to maintain respiration and administering antihistamines, epinephrine, or corticosteroids to treat anaphylaxis, especially if the patient is severely compromised. {25} {26}


Topical Dosage Forms

IODINE TINCTURE USP

Usual adult and adolescent dose
Antibacterial (topical)
Topical, to the affected area, as necessary. {02}


Note: This medication should not be used for more than ten days. {02}


Usual pediatric dose
Antibacterial (topical)
Children up to 1 month of age: Use is not recommended. {01} {14} {18} {19} {22}

Children 1 month of age and over—See Usual adult and adolescent dose. {01}


Strength(s) usually available
U.S.—


2% (OTC)[Generic](alcohol 47%)(sodium iodide 2.4%)

Canada—
Not commercially available.

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), in a tight container, unless otherwise specified by manufacturer. {16} {27}

Incompatibilities:
Tincture of iodine is incompatible with ammonia; salts of iron, bismuth, copper, lead, and mercury; potassium chlorate and other oxidizing agents; mineral acids; strychnine hydrochloride; and quinine sulfate and other alkaloidal salts. {01} {16}

Auxiliary labeling:
   • For external use only. {02}
   • Keep out of reach of children. {02}


STRONG IODINE TINCTURE{04}{16} USP

Usual adult and adolescent dose
See Iodine Tincture USP.

Usual pediatric dose
See Iodine Tincture USP.

Strength(s) usually available
U.S.—


7% (OTC)[Generic](alcohol 83%)(potassium iodide 5%)

Canada—
Not commercially available.

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), in a tight container, unless otherwise specified by manufacturer. {16} {27}

Incompatibilities:
Strong tincture of iodine is incompatible with ammonia; salts of iron, bismuth, copper, lead, and mercury; potassium chlorate and other oxidizing agents; mineral acids; strychnine hydrochloride; and quinine sulfate and other alkaloidal salts. {01} {16}

Auxiliary labeling:
   • For external use only.
   • Keep out of reach of children.



Developed: 02/22/1994



References
  1. Dollery C, editor. Therapeutic drugs. Edinburgh: Churchill Livingstone, 1991: 149-51.
  1. Iodine Tincture bottle label (Cumberland-Swan—US), Rec 8/93.
  1. Strand CL, Wajsbort RR, Sturmann K. Effect of iodophor vs iodine tincture skin preparation on blood culture contamination rate. JAMA 1993; 269(8): 1004-6.
  1. Olin BR, editor. Drug facts and comparisons. St. Louis: Facts and Comparisons Inc, 1992: 634.
  1. Kuipers JS, Van Weering HK. Skin disinfection with iodine compounds. Arch Chir Neerl 1973; 25(1): 53-65.
  1. Gottardi W. The influence of the chemical behavior of iodine on the germicidal action of disinfectant solutions containing iodine. J Hosp Infect 1985 Mar; 6 Suppl A: 1-11.
  1. Grant J. Chemical disinfection: choices and application. Trop Doct 1977 Apr; 7(2): 73-5.
  1. Jawetz E. Disinfectants and antiseptics. In: Katzung BG, editor. Basic and clinical pharmacology. Norwalk: Appleton and Lange, 1992: 691-4.
  1. White JJ, Wallace CK, Burnett LS. Skin disinfection. Johns Hopkins Med J 1970 Mar; 126(3): 169-76.
  1. Selwyn S. Evaluation of skin disinfectants in vivo by excision biopsy and other methods. J Hosp Infect 1985 Mar; 6 Suppl A: 37-43.
  1. Selwyn S, Ellis H. Skin bacteria and skin disinfection reconsidered. Br Med J 1972 Jan; 1: 136-40.
  1. Taylor GR, Butler M. A comparison of the virucidal properties of chlorine, chlorine dioxide, bromine chloride, and iodine. J Hyg 1982; 89: 321-8.
  1. Aursnes J. Ototoxic effect of iodine disinfectants. Acta Otolaryngol 1982; 93(3-4): 219-26.
  1. World Health Organization (WHO) Pharmaceuticals Newsletter 1992 Oct; 10: 5-6.
  1. Ciancio SG, Bourgault PC. Clinical pharmacology for dental professionals. 2nd ed. Littleton: PSG Publishing Co., 1984: 76-7.
  1. Iodine material data sheet (Humco Lab.—US), Rec 7/93.
  1. Accepted dental therapeutics. 40th ed. Chicago: American Dental Association, 1984: 318-21.
  1. Chanoine JP, Bourdoux P, Vo Thi NB, Ermans AM. Iodine contamination of urine samples by test strips. Clin Chem 1987; 33(10): 1935.
  1. L'Allemand D, Gruters A, Beyer P, Weber B. Iodine in contrast agents and skin disinfectants is the major cause for hypothyroidism in premature infants during intensive care. Horm Res 1987; 28(1): 42-9.
  1. Lewis P, editor. Clinical pharmacology in obstetrics. Bristol: John Wright & Sons, Ltd., 1983: 139-40.
  1. Briggs GG, Freeman RK, Yaffe SJ. A reference guide to fetal and neonatal risk. Drugs in pregnancy and lactation. 3rd ed. Baltimore: Williams & Wilkins, 1990: 32.
  1. Gruters A, L'Allemand D, Heidemann PH, Schurnbrand P. Incidence of iodine contamination in neonatal transient hyperthyrotropinemia. Eur J Pediatr 1983 Sept; 140(4): 299-300.
  1. Fleeger CA, editor. USAN 1993. USAN and the USP dictionary of drug names. Rockville, MD: The United States Pharmacopeial Convention, Inc., 1992: 333.
  1. Drug evaluations subscription. Chicago: American Medical Association, Spring 1990: 4.4-6.
  1. Dreisbach RH, Robertson WO. Handbook of poisoning: Prevention, diagnosis, and treatment. 12th ed. Norwalk, CT: Appleton and Lange, 1987: 362-4.
  1. Haddad LM, Winchester JF. Clinical management of poisoning and drug overdose. Philadelphia: W. B. Saunders Co., 1983: 697-703.
  1. The United States pharmacopeia. The national formulary. USP 22nd revision (January 1, 1990). NF 17th ed (January 1, 1990). Rockville, MD: The United States Pharmacopeial Convention, Inc., 1990: 703.
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