Povidone-iodine for healthcare professionals during the COVID-19 pandemic
Dear colleagues, esteemed healthcare professionals, we are going through a difficult period affecting us all. While experiencing the concern of ourselves and our loved ones falling ill, we are also practicing our profession, striving to prevent the spread of the disease and heal our patients.
As is known, in late 2019, a novel coronavirus, SARS-CoV-2, which causes the Coronavirus disease 2019 (COVID-19), emerged in Wuhan, China, and on March 11, 2020, the World Health Organization declared a pandemic. Povidone-iodine (PVP-I) possesses superior antiviral activity compared to other antiseptics and has been proven in vitro to be an effective virucide against severe acute respiratory syndrome and Middle East respiratory syndrome coronaviruses (SARS-CoV and MERS-CoV). Studies have shown that povidone-iodine is a safe treatment when inhaled nasally or used as a gargle. In the current COVID-19 outbreak, in order to limit the transmission of SARS-CoV-2 from patients to healthcare professionals and thus reduce the incidence of COVID-19, protocols recommend using PVP-I nasal inhalation and oropharyngeal irrigation. Regular use is recommended in COVID-19 patients to limit upper respiratory tract SARS-CoV-2 contamination, and it should also be used by healthcare professionals around the mouth/nose for protection while treating COVID-19 patients or in their daily lives.
The Use of Povidone-Iodine Nasal Spray and Gargle During the COVID-19 Outbreak Can Protect Healthcare Professionals and Reduce Cross-Infection.
Formula:
Rp.
Povidone-iodine 10.0 g
Dibasic sodium phosphate, anhydrous 1.65 g
Citric acid, anhydrous 0.84 g
Distilled water ad 100 g
Substances in the formula:
Povidone-iodine- Povidone-iodine [JAN; JP XIII; USP 24]- Polyvidon-iod-salbe [DAC 1988]:
Povidone-iodine is a complex formed by iodine and povidone. According to the United States Pharmacopeia (USP), Povidone-Iodine (Povidone-Iodine, USP 23) contains 9-12% iodine calculated on the anhydrous substance. It is a yellowish-brown powder with a slight characteristic odor. When dried, it loses not more than 8% of its weight. It is soluble in alcohol; practically insoluble in acetone, carbon tetrachloride, chloroform, ether, and petroleum ether. According to USP, the pH of its solutions is 1.5-6.5. According to the British Pharmacopoeia (BP), the pH of its solution containing 0.85-1.20% povidone-iodine ranges between 3.0 and 5.5. Povidone-iodine is an iodophor primarily used for the treatment of contaminated wounds, abrasions, and minor burns, pre-operative antisepsis of skin and mucous membranes, and disinfection of surgical instruments. Iodophors are loose complexes consisting of iodine and carrier polymers. Povidone-iodine solution exerts activity against bacteria, viruses, protozoa, cysts, and spores depending on the iodine it releases slowly. Although its efficacy is weaker than preparations containing free iodine, its toxicity is lower. When applied to wounds, it causes less irritation and burning compared to them and stains the skin more lightly. It has a wide variety of topical formulations. In most of these, the povidone-iodine concentration is 4-10%. Its 1% gargles are used in the treatment of oral infections; 0.5-5% dusting powders have been used in the treatment and prophylaxis of wound infections. There are also vaginal suppositories containing 200 mg of povidone-iodine. The antiseptic disinfectant effect of povidone-iodine depends on the iodine it contains. Its 10% solution demonstrates efficacy equivalent to a 1% free iodine solution. Iodine acts by oxidizing the thiol (-SH) groups of proteins and enzymes into disulfide (-S-S-) form. Thus, it is effective by disrupting the structure and functions of these substances. It kills all microorganism types, including viruses, and spores.
Povidone-iodine may cause hypersensitivity reactions. Although severe reactions are rare and it is considered less irritating than iodine in this respect, it may cause irritation to the skin and mucous membranes. Its application to severe burns or large areas of broken (denuded) skin may lead to systemic adverse effects related to iodine. The main ones are metabolic acidosis, hypernatremia, and impairment of renal function; seizures have also been reported. Anaphylactic shock associated with the vaginal use of povidone-iodine solution has been reported. Povidone-iodine is applied topically to the skin. It has preparations in the form of gargles for use against intraoral infections. It is applied in the form of intravaginal suppositories against vaginitis. Iodine-containing preparations are absorbed slowly when applied to the skin. Iodine and iodides passing into the systemic circulation are taken up by the thyroid gland. Iodine not taken up by the thyroid is mainly excreted in the urine, and in smaller amounts in feces, saliva, and sweat. Iodine crosses the placenta and passes into breast milk. Povidone-iodine should not be used in breastfeeding mothers; iodine absorbed from vaginal preparations concentrates in milk; the infant should be closely monitored for adverse effects such as hypothyroidism.
Anhydrous dibasic sodium phosphate- Natriummonohydrogenphosphat, wasserfreies [PH8; Ph.Eur.]:
According to the British Pharmacopoeia (BP), disodium hydrogen phosphate dihydrate is a white or almost white or colorless powder. According to the United States Pharmacopeia (USP), the anhydrous form is a powder that readily absorbs moisture. 1 g of anhydrous dibasic sodium phosphate contains approximately 14.1 mmol sodium and 7.0 mmol phosphate. 1 g of dibasic sodium phosphate (dihydrate) contains approximately 11.2 mmol sodium and 5.6 mmol phosphate.
Soluble in water; practically insoluble in alcohol. Solubilities of the dodecahydrate: Freely soluble in water; practically insoluble in alcohol. Solubilities of the anhydrous form according to USP: Soluble in water at a ratio of 1:8; insoluble in alcohol. Heptahydrate form: Freely soluble in water; very slightly soluble in alcohol.
Citric acid, anhydrous- Citronensäure [ABDATA-SK; ASK; Ph.Eur.]- Acide citrique anhydre [FP]:
Citric acid and sodium citrate are orally administered alkalinizing agents. Preparations containing citric acid are used for dissolving kidney stones, alkalinizing urine, and preventing the encrustation of urinary catheters. On the other hand, solutions containing citric acid at a ratio of 1:500 are used as mouth and foot disinfectants.
Preparation of the formula:
Combine the active ingredients by weighing them separately in a 200 ml tared amber glass bottle. (Dissolve 0.84 g anhydrous citric acid and 1.65 g sodium monohydrogen phosphate dihydrate in 80 g freshly boiled and cooled purified water. Slowly add 10.0 g povidone-iodine onto it, stirring after each addition). The solution is stirred for 12 hours using a magnetic stirrer. When the substances are completely dissolved in the glass bottle, it is brought up to 100 g with freshly boiled and cooled purified water, taking the tare into account.
The prepared aqueous solution is used for disinfection of skin and mucous membranes, treatment of burns, bedsores, ulcers, mycotic dermatitis, acne, and other skin conditions caused by bacteria, fungi, and viruses, as well as disinfection of medical equipment.
It is stored at a temperature between 15 C0 and 25 C0. Its shelf life is 6 months, and its in-use shelf life is 2 months.
Due to the potential for an increase in PBI (Protein-bound iodine), prolonged treatment applications to large and damaged skin surfaces exceeding one week should be avoided. Contact with eyes must be avoided.
To remove povidone-iodine stains, a solution of 10 g sodium thiosulfate pentahydrate in 20 g isopropyl alcohol and 70 g purified water is used.
The pH value of the aqueous povidone-iodine solution is approximately 4.5. Combination with mercury salts should be avoided (increased absorption due to complex formation); mixing with oxidants such as hydrogen peroxide is not recommended (mutual inactivation). It is better to wait a few minutes before applying the povidone-iodine solution to a wound cleaned with hydrogen peroxide.
The color of povidone-iodine may mask injuries.
Posology: A dressing with the solution is applied to the lesions to be treated once to several times daily using a gauze.
Source:
1- Therapeutisch magistraal formularium. Uitgave 2010
2- RxMediaPharma®2020 Interactive Drug Information Resource
Exp. Pharm. Ahmet Nezihi Pekcan
Pekcan Pharmacy – Konya
[email protected]
Tel: (332) 3520657
http://www.majistralformul.com/
