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Hydrogen Peroxide

Pronunciation

(HYE droe jen per OKS ide)

Index Terms

  • Eskata
  • H2O2
  • Hydrogen Dioxide
  • Peroxide

Dosage Forms

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

Gel, Mouth/Throat:

Peroxyl Spot Treatment: 1.5% (15 g) [mint flavor]

Solution, External:

GoodSense Hydrogen Peroxide: 3% (473 mL)

Generic: 3% (30 mL, 120 mL [DSC], 237 mL [DSC], 473 mL, 480 mL [DSC], 946 mL, 3840 mL)

Solution, Mouth/Throat:

Perox-A-Mint: 1.5% (44 mL, 237 mL [DSC]) [alcohol free; contains brilliant blue fcf (fd&c blue #1), fd&c yellow #6 (sunset yellow), polysorbate 80, saccharin sodium]

Brand Names: U.S.

  • GoodSense Hydrogen Peroxide [OTC]
  • Perox-A-Mint [OTC]
  • Peroxyl Spot Treatment [OTC]

Pharmacologic Category

  • Antibacterial, Topical
  • Antibiotic, Oral Rinse

Pharmacology

Antiseptic oxidant that slowly releases oxygen and water upon contact with serum or tissue catalase

The mechanism of action for the treatment of seborrheic keratosis is unknown.

Absorption

None

Duration of Action

Only while bubbling action occurs.

Use: Labeled Indications

Antiseptic; minor dermal abrasion: Cleanse wounds, suppurating ulcers, and local infections; used in the treatment of inflammatory conditions of the external auditory canal

Mouth, gum, or dental irritation; Removal of oral secretions: Used as a mouthwash or gargle

Seborrheic keratosis (topical solution 40% only): Treatment of seborrheic keratoses

Contraindications

Should not be used in abscesses.

Topical solution 40%: There are no contraindications listed in the manufacturer's labeling

Dosing: Adult

Antiseptic; minor dermal abrasion: Topical solution (3%), spray (3%): Apply a small amount to affected area(s) 1 to 3 times daily

Removal of oral secretions: Topical solution (3%): After dilution, swish solution around mouth over affected area for at least 1 minute, then spit out; may use up to 4 times daily after meals and bedtime

Mouth, gum, or dental irritation:

Oral rinse (1.4%): Topical: 10 mL swished around mouth over affected area for at least 1 minute, then spit out; may use up to 4 times daily after meals and at bedtime

Oral gel (1.7%): Topical: Apply several drops to affected area, allow medication to remain on site for at least 1 minute, then spit out; may use up to 4 times daily after meals and at bedtime

Seborrheic keratoses (raised): Topical solution (40%): Apply to lesions 4 times, ~1 minute apart, during a single in-office treatment session. If the treated lesions have not completely cleared ~3 weeks after treatment, may repeat

Dosing: Pediatric

Antiseptic; minor dermal abrasion: Children ≥2 years and Adolescents: Topical solution (3%), spray (3%): Refer to adult dosing.

Removal of oral secretions: Children ≥2 years and Adolescents: Topical solution (3%): Refer to adult dosing.

Mouth, gum, or dental irritation: Children ≥2 years and Adolescents:

Oral rinse (1.4%): Topical: Refer to adult dosing.

Oral gel (1.7%): Topical: Refer to adult dosing.

Administration

Topical: Dermal application:

Solution/spray (3%): Do not shake. Hold container away from face when opening. Clean the affected area prior to application. May cover with a sterile bandage after solution has dried. Solutions with a concentration >3% are irritants and must be diluted prior to use.

Solution (40%): For topical use only; not for oral, ophthalmic, or intravaginal use. Prior to application, clean lesions with alcohol wipe. Refer to manufacturer's labeling for preparation instructions. Apply solution directly to the lesion in a circular motion, uniformly wetting the lesion surface, including the edges without excess running or dripping. Do not apply to open or infected lesions. During the application, remove any excess solution from the surrounding skin using a clean absorbent wipe (do not use paper towels or tissue). Apply again in the same manner, 3 additional applications 1 minute apart.

Topical: Oral application: For topical use only; do not swallow. Children <12 years of age should be supervised during use.

Removal of oral secretions: Solution (3%): Mix with equal amounts of water; swish around mouth over affected area for at least 1 minute, then spit out.

Mouth, gum, or dental irritation:

Oral rinse (1.4%): Swish around the mouth over affected area for at least one minute, then spit out.

Gel (1.7%): Apply to affected area(s) of mouth. Allow to remain in place for at least 1 minute, then spit out.

Storage

Store at room temperature.

Drug Interactions

Taurolidine: May enhance the adverse/toxic effect of Hydrogen Peroxide. Specifically, concomitant use of taurolidine and hydrogen peroxide may increase the risk of metabolic acidosis. Avoid combination

Adverse Reactions

>10%:

Cardiovascular: Edema (91%)

Dermatologic: Stinging of the skin (97%), desquamation (90%), crusted skin (81%), erythema (67%), pruritus (58%), hyperpigmentation (39%), skin vesicle (24%), hypopigmentation (19%), severe erythema (19%), skin erosion (15%)

1% to 10%: Dermatologic: Dermal ulcer (9%), skin atrophy (4%), scarring (3%)

<1%, postmarketing, and/or case reports: Eyelid edema, herpes zoster

Warnings/Precautions

Concerns related to adverse effects:

• Dermatologic reactions: Have occurred in the treatment area after application for seborrheic keratoses; severe reactions included erosion, ulceration, vesiculation, and scarring. Do not initiate a second treatment course for seborrheic keratoses until the skin has recovered from any reaction caused by the previous treatment.

Dosage forms specific issues:

• Topical solution 40%: 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. If accidental exposure occurs, flush with water for 15 to 30 minutes and further evaluate as appropriate.

Other warnings/precautions:

• Appropriate use: Repeat use as a mouthwash or gargle may produce irritation of the buccal mucous membrane or "hairy tongue"; bandages should not be applied too quickly after its use; 10% and 30% solutions must be diluted prior to use.

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?)

• Have patient report immediately to prescriber severe application site irritation (HCAHPS).

• 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 health care 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.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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