Pronunciation: EYE-oh-dine
Class: Antiseptic, Expectorant, Thyroid, Topical, Trace metal

Trade Names

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

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

Iosat
- Tablets, oral potassium iodide 130 mg

Pima
- Syrup, oral potassium iodide 325 mg per 5 mL

SSKI
- Solution, oral potassium iodide 1 g/mL

Strong Iodine (Lugol's Solution)
- Solution, oral iodine 5% (50 mg/mL) and potassium iodide 10% (100 mg/mL) in water

Strong Iodine Tincture
- Solution, topical iodine 7% and potassium iodide 5% in alcohol 83%

ThyroSafe
- Tablets, oral potassium iodide 65 mg

ThyroShield
- Solution, oral potassium iodide 65 mg/mL

Pharmacology

Antiseptic

Topical iodine possesses microbicidal properties.

Thyroid drug

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

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Expectorant

Enhances secretion of respiratory fluids, decreasing mucus viscosity.

Nutritional

Integral part of thyroid hormones, triiodothyronine (T3) and thyroxine (T4), which regulate basal metabolism.

Indications and Usage

Antiseptic

Externally, to achieve broad microbicidal benefits.

Thyroid agent

As adjunct to antithyroid drug in hyperthyroid patients to prepare for thyroidectomy and to treat thyrotoxic crisis or neonatal thyrotoxicosis (Lugol's solution); thyroid blocking in radiation emergency ( Iosat , ThyroSafe , ThyroShield ).

Nutritional

Supplement to IV solutions given for TPN.

Expectorant

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.

Injection

Do not give undiluted by direct injection into a peripheral vein.

Iosat , ThyroSafe , ThyroShield

Dermatitis herpetiforms; hypocomplementemic vasculitis; nodular thyroid disease with heart disease.

Dosage and Administration

Topical Antiseptic

Apply as needed to intact skin.

Thyroid Agent Prior to Thyroidectomy
Adults and Children

PO 0.3 mL of strong iodine solution (Lugol's solution) 3 times daily (range, 0.1 to 0.9 mL daily) for 10 days prior to surgery.

Thyroid Blocking in Radiation Emergency ( Iosat , ThyroSafe , ThyroShield )

Use at direction of state or local public health authorities.

Adults and Children 12 to 18 y of age (and at least 68.2 kg)

PO 130 mg once daily.

Children 12 to 18 y of age (and less than 68.2 kg) and children 3 to 12 y of age

PO 65 mg once daily.

Children 1 mo to 3 y of age

PO 32.5 mg once daily.

Children birth to 1 mo of age

PO 16.25 mg once daily.

Supplementation in Patients Receiving TPN (Supplied as Sodium Iodide)
Metabolically Stable Adults

IV Iodine 1 to 2 mcg/kg/day (healthy adults, 75 to 150 mcg/day) added to the TPN.

Pregnant and Breast-Feeding Women, Growing Children

Iodine 2 to 3 mcg/kg/day added to the TPN.

Expectorant
Pima Adults

PO 5 to 10 mL 3 times daily.

Children 3 y of age and older

PO 5 mL 3 times daily.

Children younger than 3 y of age

PO 2.5 mL 3 times daily.

SSKI Adults

PO 0.3 mL (300 mg) to 0.6 mL (600 mg) 3 or 4 times daily (not to exceed 12 doses per day).

Renal Function Impairment

Adjust or omit dose of sodium iodide injection as needed.

General Advice

• Injection
• Do not give undiluted by direct injection into a peripheral vein.
• Add to TPN solution.
• Sodium iodine is a hypotonic solution and should be administered in admixtures only.

• Oral
• Measure solutions carefully with calibrated dropper.
• Dilute expectorant SSKI in 1 glassful of flavored beverages (eg, chocolate or plain milk, orange juice) to minimize bitter taste. Each dose of Pima or SSKI should be taken with food and with 120 to 240 mL of water.
• Dilute strong iodine solution (Lugol's solution) in water or juice prior to administration.
• Have patient sip expectorant through straw to decrease burning sensation in mouth and to prevent discoloration of teeth.
• Potassium iodide tablets may be administered whole or crushed. Refer to individual product's package insert for instructions on preparation of a liquid mixture from potassium iodide tablets.

Storage/Stability

Store in airtight, light-resistant container at room temperature (59° to 86°F). Store sodium iodide injection at 68° to 77°F. Store Iosat and ThyroSafe at 68° to 77°F; keep dry and foil intact.

Drug Interactions

Lithium

May have synergistic hypothyroid activity; may result in hypothyroidism.

Potassium-sparing diuretics

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

Acne; rash.

EENT

Swelling of neck, throat, or salivary glands.

GI

Bleeding.

Metabolic

Acute parotitis; goiter; myxedema; thyroid adenoma; thyroid gland enlargement.

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

Warnings Potassium iodide should only be used during a nuclear radiation emergency when recommended by public officials. Potassium iodide only protects the thyroid gland from uptake of radioactive iodine and should therefore be used along with other emergency measures recommended by public officials. Potassium iodide for use during a nuclear radiation emergency should only be taken once every 24 h; higher amounts do not provide additional benefits and may increase risk of adverse reactions.

Pregnancy

Category D (potassium iodide). For use in a nuclear radiation emergency, pregnant women should take potassium iodide as described previously and contact their health care provider as soon as possible. Repeat dosing should be avoided. The benefits of short-term use to block uptake of radioactive iodine by the thyroid gland far exceed the risks of adverse reactions.

Lactation

Excreted in breast milk. According to the American Academy of Pediatrics, these agents are not contraindicated in breast-feeding. For use in a nuclear radiation emergency, breast-feeding women should take potassium iodide as described previously and contact their health care provider as soon as possible. Repeat dosing should be avoided. The benefits of short-term use to block uptake of radioactive iodine by the thyroid gland far exceed the risks of adverse reactions.

Children

Safety and efficacy of SSKI have not been established.

Hypersensitivity

May occur. Deaths due to anaphylactic shock have been reported.

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.

Aluminum toxicity

Parenteral products may contain aluminum that may be toxic. Aluminum may reach toxic levels with prolonged parenteral administration if kidney function is impaired. Premature neonates are particularly at risk.

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 due to shock, corrosive gastritis, or asphyxiation from swelling of glottis or larynx.

Chronic iodide poisoning may cause metallic taste, soreness in the mouth, increased salivation, coryza, sneezing, swelling of the eyelids, severe headache, pulmonary edema, tenderness of salivary glands, acneiform skin lesions, skin eruptions.

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.
• Advise patient that parenteral medication will be prepared and administered by a health care provider in a hospital setting.
• Instruct patients to dilute strong iodine solution (Lugol's solution) with water or fruit juice before administration.
• Instruct patients to dilute each dose of SSKI in 1 glassful of water, fruit juice, or milk. Advise patients to take each dose of Pima or SSKI with at least 120 to 240 mL of water. To minimize gastric irritation, take with food or milk.
• Inform patients that potassium iodide tablets may be administered whole or crushed.

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