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Iodine

Pronunciation

(EYE oh dyne)

Index Terms

  • Iodoflex
  • Iodosorb

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Tincture, External:

Generic: 2% (30 mL, 473 mL, 500 mL, 4000 mL, 20000 mL); 7% (28.35 mL [DSC], 30 mL, 59 mL, 100 mL [DSC], 473 mL [DSC], 480 mL, 500 mL [DSC], 4000 mL [DSC]); (30 mL)

Pharmacologic Category

  • Antiseptic, Topical

Pharmacology

Iodine is required for thyroid hormone synthesis. Iodine is also known to be a powerful broad spectrum germicidal agent effective against a wide range of bacteria, viruses, fungi, protozoa, and spores. Iodosorb® and Iodoflex™ contain iodine in hydrophilic beads of cadexomer which allows a slow release of iodine into the wound and absorption of fluid, bacteria, and other substances from the wound

Absorption

Topical: Amount absorbed systemically depends upon concentration and characteristics of skin

Distribution

Primarily trapped by the thyroid

Metabolism

Degraded by amylases normally present in wound fluid

Excretion

Urine (>90%)

Use: Labeled Indications

Used topically as an antiseptic in the management of minor, superficial skin wounds and has been used to disinfect the skin preoperatively

Contraindications

Hypersensitivity to iodine or any component of the formulation

Iodosorb®, Iodoflex™: Hashimoto thyroiditis, history of Grave’s disease, or nontoxic nodular goiter; pregnancy; breast-feeding

Dosage

Topical:

Cleaning wet ulcers and wounds (Iodosorb®, Iodoflex™): Apply to clean wound; maximum: 50 g/application and 150 g/week. Change dressing ~3 times/week; reduce applications as exudate decreases. Do not use for >3 months; discontinue when wound is free of exudate.

Antiseptic for minor cuts, scrapes, burns: Apply small amount to affected area 1-3 times/day

Oral: RDA:

Children:

1-8 years: 90 mcg/day

9-13 years: 120 mcg/day

≥14 years: Refer to adult dosing

Adults: 150 mcg/day

Pregnancy: 220 mcg/day

Breast-feeding: 290 mcg/day

Administration

Topical: Iodosorb®: Apply 1/8" to 1/4" thickness to dry sterile gauze, then place prepared gauze onto clean wound. Change dressing when gel changes color from brown to yellow/gray (~3 times/week). Remove with sterile water, saline, or wound cleanser; gently blot fluid from surface leaving wound slightly moist before reapplying gel.

Dietary Considerations

Some dietary sources of iodine include cow's milk and dairy products, fish, seaweed, eggs, chocolate and iodized salt.

Storage

Store at room temperature.

Drug Interactions

There are no known significant interactions.

Test Interactions

Large amounts from excessive absorption may alter thyroid function tests.

Adverse Reactions

Reactions reported following topical application: Frequency not defined:

Endocrine & metabolic: TSH increased

Local: Eczema, edema, irritation, pain, redness

Miscellaneous: Allergic reaction

Reactions reported more likely observed following large doses or chronic iodine intoxication; frequency not defined:

Central nervous system: Fever, headache

Dermatologic: Skin rash, angioedema, urticaria, acne

Endocrine & metabolic: Hypothyroidism

Gastrointestinal: Metallic taste, diarrhea

Hematologic: Eosinophilia, hemorrhage (mucosal)

Neuromuscular & skeletal: Arthralgia

Ocular: Swelling of eyelids

Respiratory: Pulmonary edema

Miscellaneous: Ioderma, lymph node enlargement

Warnings/Precautions

Disease-related concerns:

• Renal impairment: Use with caution in patients with renal impairment.

Dosage form specific issues:

• Iodosorb: For use as topical application to wet wounds only.

Other warnings/precautions:

• Appropriate use: Not for application to large areas of the body or for use with tight or air-excluding bandages. When used as a topical antiseptic, improper use may lead to product contamination. Although infrequent, product contamination has been associated with reports of localized and systemic infections. To reduce the risk of infection, ensure antiseptic products are used according to the labeled instructions; avoid diluting products after opening; and apply single-use containers only one time to one patient and discard any unused solution (FDA Drug Safety Communication, 2013).

• OTC labeling: When used for self-medication (OTC), do not use on deep wounds, puncture wounds, animal bites, or serious burns without consulting with health care provider. Notify healthcare provider if condition does not improve within 7 days.

Monitoring Parameters

Thyroid function should be monitored in pregnant women, neonates, and young infants if repeat applications over large areas are needed.

Pregnancy Considerations

An adequate amount of iodine intake is essential for thyroid function. Iodine crosses the placenta and requirements are increased during pregnancy. Iodine deficiency in pregnancy can lead to neurologic damage in the newborn; an extreme form, cretinism, is characterized by gross mental retardation, short stature, deaf mutism, and spasticity. Large amounts of iodine during pregnancy can cause fetal goiter or hyperthyroidism. Transient hypothyroidism in the newborn has also been reported following topical or vaginal use prior to delivery.

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.

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