Povidone-Iodine

(BAN)
Synonyms: Iodinated Povidone; Jodowany powidon; Polyvidone-Iodine; Polyvinylpyrrolidone-Iodine Complex; Povidon, joderad; Povidon jodovaný; Povidona yodada; Povidonas, joduotas; Povidone iodée; Povidoni, jodattu; Povidon-Iyot; Povidon-jód; Povidonum iodinatum; Propyléneglycol, monostéarate de; PVP-Iodine; PVP-Iodine.
Cyrillic synonym: Повидон-йод.

💊 Chemical information

CAS — 25655-41-8.
ATC — D08AG02; D09AA09; D11AC06; G01AX11; R02AA15; S01AX18.

Pharmacopoeias.

In Chin., Eur., Jpn, and US.

Ph. Eur. 6.2

(Povidone, Iodinated). A complex of iodine with povidone containing 9 to 12% of available iodine calculated with reference to the dried substance. Yellowish-brown or reddishbrown amorphous powder. It loses not more than 8% of its weight on drying. Soluble in water and in alcohol; practically insoluble in acetone. A 10% solution in water has a pH of 1.5 to 5.0. Protect from light.

USP 31

(Povidone-Iodine). A complex of iodine with povidone containing 9 to 12% of available iodine calculated on the dried basis. A yellowish-brown to reddish-brown amorphous powder with a slight characteristic odour. It loses not more than 8% of its weight on drying. Soluble in water and in alcohol; practically insoluble in acetone, in carbon tetrachloride, in chloroform, in ether, and in petroleum spirit. Its solutions are acid to litmus. Store in airtight containers.

Incompatibility.

Antimicrobial activity may be reduced at high pH. Dermatological reactions, described as second- and third-degree burns, were observed in 4 patients in whom wounds were covered with a povidone-iodine soaked bandage secured to the skin by compound benzoin tincture. It was suggested that an interaction had occurred resulting in a more acidic pH. 1 A mixture of povidone-iodine solution and hydrogen peroxide [brown bubbly] has caused explosions. 2 1. Schillaci LJ, et al. Reduced pH associated with mixture of povidone-iodine and compound tincture of benzoin. Am J Hosp Pharm 1983; 40: 1694–5. 2. Dannenberg E, Peebles J. Betadine-hydrogen peroxide irrigation solution incompatibility. Am J Hosp Pharm 1978; 35: 525.

💊 Adverse Effects and Precautions

Povidone-iodine can cause hypersensitivity reactions and irritation of the skin and mucous membranes, although severe reactions are rare and povidone-iodine is considered to be less irritant than iodine. The application of povidone-iodine to severe burns or to large areas otherwise denuded of skin may produce the systemic adverse effects associated with iodine and metabolic acidosis, hypernatraemia, and renal impairment. Hyperthyroidism or hypothyroidism may occur after ingestion or absorption of large quantities. Hypothyroidism has occurred in neonates both as a result of absorption of iodine from povidoneiodine applied to the neonate and also to the mother during pregnancy or breast feeding. Povidone-iodine application is contra-indicated in premature neonates or those weighing less than 1.5 kg. Regular or prolonged use should be avoided in patients with thyroid disorders or those receiving lithium therapy.

Acidosis.

There have been reports of acidosis in patients whose burns were treated topically with povidone-iodine.1,2 Fatal metabolic acidosis3 and seizures4 have been reported after mediastinal irrigation with povidone-iodine.
1. Pietsch J, Meakins JL. Complications of povidone-iodine absorption in topically treated burn patients. Lancet 1976; i: 280–2
2. Scoggin C, et al. Hypernatraemia and acidosis in association with topical treatment of burns. Lancet 1977; i: 959
3. Glick PL, et al. Iodine toxicity in a patient treated by continuous povidone-iodine mediastinal irrigation. Ann Thorac Surg 1985; 39: 478–80
4. Zec N, et al. Seizures in a patient treated with continuous povidone-iodine mediastinal irrigation. N Engl J Med 1992; 326: 1784.

Breast feeding.

Use of povidone-iodine in a vaginal gel by a breast-feeding woman resulted in elevated iodine concentrations in the breast milk and an odour of iodine on the infant’s skin.1The American Academy of Pediatrics considers however that the use of povidone-iodine is usually compatible with breast feeding.2 For more on precautions in breast feeding when treated with iodine compounds.
1. Pastellon DC, Aranow R. Iodine in mother’s milk. JAMA 1982; 247: 463
2. American Academy of Pediatrics. The transfer of drugs and other chemicals into human milk. Pediatrics 2001; 108: 776–89. Correction. ibid.; 1029. Also available at: http://aappolicy.aappublications.org/cgi/content/full/ pediatrics%3b108/3/776 (accessed 15/03/06)

Hypersensitivity.

Immediate type I hypersensitivity reactions have been reported after topical disinfection with povidoneiodine; anaphylaxis has been reported after vaginal application1,2and after wound disinfection during surgery.3 In some cases2,3skin tests showed that the reactions were caused by the povidone component. Contact dermatitis has been reported4 in a 36-year-old man who received a compress with 10% povidone-iodine aqueous solution under an occlusive bandage. The patient experienced mild itching, erythema, exudation, and a bullous reaction, limited to the area of the compress, 48 hours after application. He responded to topical corticosteroids within 5 to 6 days, but an area of sharply demarcated brown hyperpigmentation persisted for a month. While this was considered to be suggestive of an irritant effect, a positive patch test supported an allergic mechanism. A study to evaluate the incidence of contact dermatitis associated with povidone-iodine5 found that 14 of 500 patients (2.8%) had a positive patch test with 10% povidone-iodine aqueous solution. On retesting with the same solution using a repeated open application test only 2 of the 14 (0.4%) were found to have true contact dermatitis to povidone-iodine.
1. Waran KD, Munsick RA. Anaphylaxis from povidone-iodine. Lancet 1995; 345: 1506
2. Adachi A, et al. Anaphylaxis to polyvinylpyrrolidone after vaginal application of povidone-iodine. Contact Dermatitis 2003; 48: 133–6
3. Le Pabic F, et al. First case of anaphylaxis to iodinated povidone. Allergy 2003; 58: 826–7
4. Borja JM, et al. Contact dermatitis due to povidone-iodine: allergic or irritant? J Investig Allergol Clin Immunol 2003; 13: 131–2
5. Lachapelle JM. Allergic contact dermatitis from povidone-iodine: a re-evaluation study. Contact Dermatitis 2005; 52: 9–10.

Neonates.

Hypothyroidism has been reported in premature and very low birth-weight infants after the use of povidone-iodine for routine antisepsis,1,2 and hyperthyroidism in a full-term infant following mediastinal lavage.3 Perinatal vaginal use of povidone-iodine may also cause neonatal thyroid dysfunction.4
1. Parravicini E, et al. Iodine, thyroid function, and very low birth weight infants. Pediatrics 1996; 98: 730–4
2. Linder N, et al. Topical iodine-containing antiseptics and subclinical hypothyroidism in preterm infants. J Pediatr 1997; 131: 434–9
3. Bryant WP, Zimmerman D. Iodine-induced hyperthyroidism in a newborn. Pediatrics 1995; 95: 434–6. Correction. ibid.; 96: 779
4. l’Allemand D, et al. Iodine-induced alterations of thyroid function in newborn infants after prenatal and perinatal exposure to povidone iodine. J Pediatr 1983; 102: 935–8.

💊 Uses and Administration

Povidone-iodine is an iodophore that is used as a disinfectant and antiseptic mainly for the treatment of contaminated wounds and pre-operative preparation of the skin and mucous membranes as well as for the disinfection of equipment. Iodophores are loose complexes of iodine and carrier polymers. Solutions of povidone-iodine gradually release iodine to exert an effect against bacteria, fungi, viruses, protozoa, cysts, and spores; povidone-iodine is thus less potent than preparations containing free iodine but it is less toxic. A wide variety of topical formulations is available, the majority containing about 4 to 10% of povidoneiodine; a 1% mouthwash has been used for oral infections including candidiasis and topical powders containing up to 2.5% povidone-iodine have been tried in the treatment and prevention of wound infection. For vaginal application povidone-iodine has also been used as pessaries containing 200 mg or as a 10% gel or solution.

💊 Preparations

BP 2008: Povidone-Iodine Mouthwash; Povidone-Iodine Solution; USP 31: Povidone-Iodine Cleansing Solution; Povidone-Iodine Ointment; Povidone-Iodine Topical Aerosol; Povidone-Iodine Topical Solution.

Proprietary Preparations

Arg.: Antiseptico; Clivasol†; DG-6 Iodopovidona†; Dovidox†; Extraleci; Iodep; Iodoasept†; Iodomax; Iodomine†; Iopox; IPV†; Nu-Gel Hidrogel en Placa; Pervinox; Povi Complex; Povibac; Povicler; Povitiol; Salguer†; Tycoytycoy; Austral.: Betadine; Isodine†; Logicin Sore Throat†; Microshield PVP; Microshield PVP-S; Minidine†; Nyal Medithroat Gargle†; PI Antiseptic Ointment†; Savlon Antiseptic; Viodine†; Austria: Betadona; Betaisodona; Betaso-Phthaldialdehyde/Povidone-Iodine 1659 an; Betaseptic; Braunol; Braunovidon; Wundesin; Belg.: Braunol; Iodex; IsoBetadine; Braz.: Asteriodine†; Laboriodine; Marcodine; PVPI†; Sabofen†; Canad.: Betadine; Proviodine; Chile: Difexon; Neoyod†; Cz.: Betadine; Braunol; Braunovidon; Jodisol; Jodobac†; Fin.: Betadine; Fr.: Betadine; Poliodine; Ger.: Betaisodona; Braunol; Braunovidon; Freka-cid; Inadine†; Jodobac†; Mercuchrom-Jod; Polydona; Polysept; Sepso J; Traumasept; Gr.: Betadine; Drapix; Eva Povi†; Lombocid†; Oxisept; Tinsole; Hong Kong: Betadine; Freka-cid; Proviodine; Videne; Hung.: Betadine; Colpo-Cleaner; Gyneiod†; India: Alphadine†; Betadine; Betadine-AD; Cipladine; Povidine; Wokadine; Indon.: Abodine; Asepta; Betadine; Corsasep; Duvodine; Forinfec; Isodine; Molexdine; Mugisept; Neo Iodine; Scansepta; Septadine; Vidisep; Irl.: Betadine; Inadine; Savlon Dry; Israel: Idovit; Iodiflor; Iodispray; Iodo-Vit; Massengill Medicated†; Polydine; Polysept; Yodon; Ital.: Asepsan; Betadine; Betaseptic; Braunol; Citro Jod; Destrobac; Eso-Jod; Esoform Jod 35 and 75; Gammadin; Golasept; Inadine; Iodosteril; Iodoten; Jodocur†; Jodogard; Oftasteril; Paniodal†; Paniodine†; Poviderm; Jpn: Finish; Malaysia: Betadine; Freka-cid; Poviderm; Septi-Aid; Summers Eve Medicated; Mex.: Isodine; Solvin†; Yodacua; Yodine; Neth.: Betadine; Braunol; NZ: Betadine; Biocil; Riodine; Viodine†; Philipp.: Bacticide; Betadine; Povidine; Zigmadone; Pol.: Betadine; Braunovidon; Jodi; Polodina-R; Polseptol; PV Jod; Port.: Betadine; Braunol; Dinasepte†; Ginoseptil; Iodolab; Isodine; Septil; Rus.: Betadine (Бетадин); Iodoxyd (Йодоксид); Wokadine (Вокадин); S.Afr.: Betadine; Dermadine; Drygel; Podine; Septadine; Septisooth; Steridine; Zedchem PVP-I; Singapore: Betadine; Spain: Acydona; Betadine; Betatul; Curadona; Iodina; Orto Dermo P; Sanoyodo; Topionic; Switz.: Betadine; Braunol; Braunosan; Braunosan H Plus; Braunovidon; Destrobac; Intersept; Jodoplex; Thai.: Annadine; Bactedene; Bernadine†; Betadine; Cavodine†; Eprodine†; Freka-cid; Isodine; Movidone; P-Vidine†; Povadine; Sepfadine†; Septidine; Upodine; Videne; X-Tardine; Turk.: Batticon; Betakon; Biokadin; Isosol; Polyod; Poviseptin; UK: Betadine; Inadine; Savlon Dry; Videne; USA: ACU-dyne; Betadine; Biodine; Efodine; Iodex; Massengill Medicated; Minidyne; Operand; Polydine; Summers Eve Medicated; Venez.: Betadine; Etiyodix†; Intradine; Intradyn; Iopovidona†; Jabodine†; Norlidine; Podival†; Povidine†; Yodasep†. Multi-ingredient: Arg.: Merthiolate Iodopovidona; Pervinox D; Austria: Braunoderm; Belg.: Braunoderm; Braz.: Iodocaine†; Cz.: Jox; Ger.: Betaseptic; Braunoderm; Repithel; Hung.: Eczil†; Jox†; India: Eczo-Wokadine; Indon.: Kalpanax; Kopamex; Ital.: Braunoderm; Jodieci; Jpn: U-Pasta; Mex.: Bano Coloide; Riban; Port.: Braunoderm; Rus.: Jox (Йокс); Switz.: Betaseptic; Braunoderm; Turk.: Batiodin; USA: Anbesol; Orasol; ProTech.
Published January 30, 2019.