Hydrogen Peroxide 40%

Brand name: Eskata
Drug class: Skin and Mucous Membrane Agents, Miscellaneous
Chemical name: hydrogen peroxide
Molecular formula: H₂O₂
CAS number: 218625-72-0

Introduction

Hydrogen peroxide 40% is a skin agent.

Uses for Hydrogen Peroxide 40%

Hydrogen peroxide 40% has the following uses:

Hydrogen peroxide 40% is indicated for the treatment of seborrheic keratoses that are raised.¹

Hydrogen Peroxide 40% Dosage and Administration

General

Hydrogen peroxide 40% is available in the following dosage form(s) and strength(s):

Topical solution: 40% (w/w) hydrogen peroxide.¹

Dosage

It is essential that the manufacturer's labeling be consulted for more detailed information on dosage and administration of this drug. Dosage summary:

Adults

• To be administered by a healthcare provider.¹

• For topical use only. Not for oral, ophthalmic, or intravaginal use.¹

• Do not apply hydrogen peroxide 40% topical solution to open or infected seborrheic keratoses.¹

• Prior to application, clean targeted lesion(s) using an alcohol wipe.¹ Apply hydrogen peroxide 40% topical solution 4 times, approximately 1 minute apart, to the targeted lesion(s) during a single in-office treatment session.¹ Any excess solution on the surrounding skin should be removed using a clean absorbent wipe; do not use paper towels or tissue to remove excess solution.¹

• Another treatment may be administered if the treated lesions have not completely cleared by approximately 3 weeks after treatment.¹

Cautions for Hydrogen Peroxide 40%

Contraindications

None.¹

Warnings/Precautions

Eye Disorders

Do not apply to the eyes or mucous membranes. Avoid treating seborrheic keratoses within the orbital rim. Direct contact with the eye can cause corneal injury (erosion, ulceration, perforation, and scarring), chemical conjunctivitis, eyelid edema, severe eye pain, or permanent eye injury, including blindness.¹

If accidental exposure occurs, flush with water for 15 to 30 minutes and initiate monitoring and further evaluation as appropriate.¹

Local Skin Reactions

Skin reactions occurred in the treatment area after application of hydrogen peroxide 40%. Severe local skin reactions included erosion, ulceration, vesiculation and scarring. Do not initiate a second treatment course with hydrogen peroxide 40% until the skin has recovered from any reaction caused by the previous treatment.¹

Specific Populations

Pregnancy

Hydrogen peroxide is not absorbed systemically following topical administration, and maternal use is not expected to result in fetal exposure to the drug.¹

Lactation

Hydrogen peroxide is not absorbed systemically by the mother following topical administration, and breastfeeding is not expected to result in exposure of the child to hydrogen peroxide.¹

Pediatric Use

Seborrheic keratosis is not seen in the pediatric population. ¹

Geriatric Use

Of the 841 subjects treated with hydrogen peroxide 40% in the clinical trials, 70% were 65 years of age and older and 26% were 75 years of age and older. No overall differences in safety or effectiveness were observed between these subjects and younger subjects.¹

Common Adverse Effects

Common adverse reactions include erythema (99%), stinging (97%), edema (91%), scaling (90%), crusting (81%), and pruritus (58%). ¹

Drug Interactions

Specific Drugs

It is essential that the manufacturer's labeling be consulted for more detailed information on interactions with this drug, including possible dosage adjustments. Interaction highlights:

Please see product labeling for drug interaction information.

Actions

Mechanism Of Action

The mechanism of action for hydrogen peroxide 40% for the treatment of seborrheic keratosis is unknown.¹

Advice to Patients

Advise the patient to read the FDA-approved patient labeling (Patient Information).¹

Ophthalmic Adverse Reactions: Inform patients that severe eye injury can occur with hydrogen peroxide 40% application. Advise patients to inform the healthcare provider immediately if hydrogen peroxide 40% runs into eyes, mouth, or nose during administration.¹

Local Skin Reactions: Inform patients that treatment with hydrogen peroxide 40% may lead to local skin reactions.¹

Additional Information

AHFS First Release. For additional information until a more detailed monograph is developed and published, the manufacturer's labeling should be consulted. It is essential that the manufacturer's labeling be consulted for more detailed information on usual uses, dosage and administration, cautions, precautions, contraindications, potential drug interactions, laboratory test interferences, and acute toxicity.

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

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