Iodine

Trade Names:
Iodine Tincture
- Solution 2% iodine and 2.4% sodium iodide in 47% alcohol, purified water

Trade Names:
Iodopen
- Injection 100 mcg/mL (as 118 mcg sodium iodide)

Trade Names:
SSKI
- Solution 1 g/mL potassium iodide

Trade Names:
Strong Iodine (Lugol's Solution)
- Solution 5% iodine and 10% potassium iodide in water

Trade Names:
Strong Iodine Tincture
- Solution 7% iodine and 5% potassium iodide in 83% alcohol

Pharmacology

Topical iodine possesses microbicidal properties.

Large doses of iodides inhibit thyroid hormone production and release into bloodstream.

Enhances secretion of respiratory fluids, decreasing mucus viscosity.

Indications and Usage

Externally, to achieve broad microbicidal benefits.

As adjunct to antithyroid drug in hyperthyroid patients to prepare for thyroidectomy and to treat thyrotoxic crisis or neonatal thyrotoxicosis; thyroid blocking in radiation emergency.

Supplement to IV solutions given for TPN.

Treatment of chronic pulmonary diseases complicated by tenacious mucus, including bronchial asthma, chronic bronchitis, bronchiectasis, and pulmonary emphysema; adjunctive treatment in respiratory conditions such as cystic fibrosis and chronic sinusitis and to prevent atelectasis after surgery.

Contraindications

Hypersensitivity to iodides; impaired renal function; acute bronchitis; hyperthyroidism; Addison disease; acute dehydration; heat cramps; hyperkalemia; iodism; tuberculosis.

Dosage and Administration

Apply prn to intact skin.

PO 2 to 6 drops of strong iodine solution ( Lugol's Solution ) 3 times daily for 10 days prior to surgery.

Use at direction of state or local public health authorities.

1 to 2 mcg/kg/day (healthy adults, 75 to 150 mcg/day).

2 to 3 mcg/kg/day.

PO 300 to 1,000 mg initially after meals. If tolerated, 1 to 1.5 g 3 times daily.

PO Half adult dose.

General Advice

• Do not give trace metal undiluted by direct injection into peripheral vein.

• Measure solutions carefully with calibrated dropper.
• Dilute expectorant in 60 mL of flavored beverages (eg, chocolate or plain milk, orange juice) to minimize bitter taste.
• Have patient sip expectorant through straw to decrease burning sensation in mouth and to prevent discoloration of teeth.

Storage/Stability

Store in airtight, light-resistant container at room temperature (59° to 86°F).

Drug Interactions

May have synergistic hypothyroid activity; may result in hypothyroidism.

Increase risk of hyperkalemia, cardiac arrhythmias, and cardiac arrest.

Laboratory Test Interactions

Potassium iodide may alter thyroid function test results.

Adverse Reactions

Cardiovascular

Irregular heartbeat.

CNS

Confusion; unusual tiredness.

Dermatologic

Rash; acne.

EENT

Swelling of neck, throat, or salivary glands.

GI

Bleeding.

Metabolic

Thyroid adenoma; goiter; myxedema; thyroid gland enlargement; acute parotitis.

Miscellaneous

Hypersensitivity manifested by angioneurotic edema, cutaneous and mucosal hemorrhages, and symptoms resembling serum sickness (eg, fever, arthralgia, lymph node enlargement, eosinophilia); numbness; tingling; pain or weakness in hands or feet; weakness or heaviness of legs; fever; iodism (eg, metallic taste, burning mouth and throat, sore teeth and gums, symptoms of head cold, stomach upset, diarrhea).

Precautions

Pregnancy

Category D (potassium iodide).

Lactation

Excreted in breast milk.

Children

Safety and efficacy not established.

Renal Function

Supplement dosage may be adjusted, reduced, or omitted.

Special Risk Patients

Pulmonary tuberculosis is considered a contraindication to use of iodides by some authorities; use with caution in such cases and in patients with cardiac disease, myotonia congenita, or renal impairment. Cystic fibrosis patients may have increased susceptibility to adverse effects.

GI effects

Nonspecific small bowel lesions have occurred with enteric-coated potassium salts.

Hypothyroidism (oral)

Prolonged use can lead to hypothyroidism.

Topical

For external use only; highly toxic if ingested. Avoid contact with eyes and mucous membranes. Iodine preparations stain skin and clothing.

Overdosage

Symptoms

Iodine is corrosive; toxic symptoms are related primarily to local GI tract irritation; gastroenteritis, abdominal pain, and diarrhea (sometimes bloody) may be seen; fatalities may occur from circulatory collapse, because of shock, corrosive gastritis, or asphyxiation from swelling of glottis or larynx.

Patient Information

• Tell patient to discontinue use and notify health care provider if fever, rash, metallic taste, swelling of throat, burning of mouth and throat, sore gums and teeth, head cold symptoms, severe GI distress, or enlargement of thyroid gland (goiter) occur.
• Inform patient if replacement therapy is to be taken for life.
• Explain that sudden discontinuation of drug should not be performed without health care provider's guidance.
• Teach patient about foods that are high in iodine (eg, seafood, kale, turnips, iodized salt).
• Explain that darkening of solution does not affect potency.

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