Hydrogen Peroxide

Hydrogen Peroxide is a an Antiseptic belonging to pharmacology class of Oxidising agents

Hydrogen Peroxide can be used in the treatment of Seborrheic keratosis, Antiseptic; minor dermal abrasion and Mouth, gum, or dental irritation; Removal of oral secretions.

Hydrogen peroxide breaks down in the intestine before being absorbed. When administered to tissue, hydrogen peroxide solutions have low penetration. Distribution: The lungs, colon, thymus, liver, and kidney are among the target organs that hydrogen peroxide could possibly harm. Glutathione Peroxide , an endogenous enzyme found in human tissue, reduces hydrogen peroxide. When it comes into touch with the enzyme catalase, which is present in most tissues and blood, it quickly decomposes into oxygen and water.

The common side effects associated with Hydrogen Peroxide include Burns on skin and mucous membranes (w/ white eschar), pain.

Hydrogen Peroxide is available in the form of solution and gel.

The molecule is available in countries : India, USA, Japan, Germany.

Hydrogen Peroxide belonging to the Oxidising agents acts a Antiseptic .

By producing harmful hydroxyl free radicals, hydrogen peroxide is able to destroy DNA, membrane lipids, and other vital cell constituents. By converting hydrogen peroxide to water and oxygen, catalase, which is produced by facultative anaerobes and aerobic species with cytochrome systems, can shield cells from metabolically produced hydrogen peroxide. The concentrations required for disinfection overpower this protection.

Hydrogen Peroxide is available in

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.

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 (1.5%): 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.

Hydrogen Peroxide can be used in the treatment of Seborrheic keratosis, Antiseptic; minor dermal abrasion and Mouth, gum, or dental irritation; Removal of oral secretions.

When hydrogen peroxide comes into touch with tissues that contain the enzyme catalase, it releases nascent oxygen, which has a modest antibacterial effect. Additionally, the mechanical action of the effervescence loosens pus and tissue fragments, lowering the bacterial count in wounds.

Hydrogen Peroxide is approved for use in the following clinical indications

Seborrheic keratosis (topical solution 40% only):

Treatment of raised seborrheic keratoses.

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.

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 (1.5%): Topical: 7.5 to 10 mL (amount varies by manufacturer; refer to manufacturer's labeling for detailed recommendations) swished around mouth over affected area for at least 1 minute, then spit out; may use up to 4 times daily.

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.

• The dosage and duration of treatment should be as per the clinical judgement of the treating physician)

Gel: 15 g

Solution: 44mL,59.1 mL ,236 mL, 473 mL, 946 mL, 1 mL, 30 mL, 118 mL, 480 mL, 946 mL, 3840 mL

Solution and gel.

Dose Adjustment in Pediatric patient:

Antiseptic; minor dermal abrasion:

Children ≥2 years and Adolescents: Topical solution (3%), spray (3%): Apply a small amount to affected area(s) 1 to 3 times daily

Removal of oral secretions:

Children ≥2 years and Adolescents: 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:

Children ≥2 years and Adolescents:

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.

Hydrogen Peroxide may be contraindicated in the following conditions:

Blood dyscrasias. severe renal (including those on dialysis) and hepatic impairment (when used to treat acute gout). birth and breastfeeding. P-glycoprotein (P-gp) inhibitors or potent CYP3A4 inhibitors should be used concurrently in patients with renal or hepatic impairment.

The treating physician must closely monitor the patient and keep pharmacovigilance as follows

Concerns related to adverse effects:

• Dermatologic reactions: Severe reactions, such as erosion, ulceration, vesiculation, and scarring, have occurred in the treatment area after application for seborrheic keratoses. Seborrheic keratoses should not be treated again until any side effects from the initial course of treatment diminish.

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.

• Self-medication (OTC use): When used for self-medication, ask health care provider prior to using on deep or puncture wounds, animal bites, or burns. Discontinue use and contact health care provide if condition persists or worsens; sore throat persists ≥7 days; irritation, pain, or redness persists or worsens; or if swelling, rash, or fever occur.

There is no sufficient scientific evidence traceable regarding use and safety of Hydrogen Peroxide in concurrent use with alcohol.

There is no sufficient scientific evidence traceable regarding use and safety of Hydrogen Peroxide in breast feeding.

There is no sufficient scientific evidence traceable regarding use and safety of Hydrogen Peroxide in pregnancy.

There is no sufficient scientific evidence traceable regarding use and safety of Hydrogen Peroxide in concurrent use with any particular food.

The adverse reactions related to Hydrogen Peroxide can be categorized as

Common Adverse effects: Burns on skin and mucous membranes (w/ white eschar), pain.

Less Common Adverse effects: Blistering, erythema, focal epidermal, necrosis, and purpura (concentrated soln).

Rare Adverse effects: Irritation of pulmonary membranes, coughing, dyspnea.

The clinically relevant drug interactions of Hydrogen Peroxide is briefly summarized here

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.

Risk X: Avoid combination.

The common side of Hydrogen Peroxide include the following

Burns on skin and mucous membranes (w/ white eschar), pain.

Forty-one patients received hydrogen peroxide as a treatment for head and neck tumors, administered intra-arterially in strengths ranging from 0.06-0.18% over 1-4 weeks.

• One patient received hydrogen peroxide as a treatment for reduction in arteriosclerotic plaques, administered intra-arterially in 100 infusions over 28-29 days.
• One patient received hydrogen peroxide as a treatment for vascular collapse of unknown etiology, administered intra-arterially 6 times.
• Fifteen patients received hydrogen peroxide as a treatment for delayed wound healing, administered intra-arterially and intravenously for 1 week to 3 months.

Symptoms: GI disturbance and vomiting , Sore throat, distention of stomach and internal bleeding. Management: Symptomatic and supportive treatment.

Pharmacodynamic:

Most microbe types, including latent forms with known high resistance profiles, including bacterial spores and protozoal cysts, are susceptible to hydrogen peroxide's antibacterial activities. It functions as an oxidative biocide to produce free radical species to cause oxidative damage to DNA, proteins, and membrane lipids. When peroxide comes into touch with tissues that contain the enzyme catalase, it releases nascent oxygen, which then has a modest antibacterial effect. Additionally, the mechanical action of the effervescence loosens pus and tissue fragments, lowering the bacterial count in wounds.

Pharmacokinetics:

Hydrogen Peroxide

Absorption: Hydrogen peroxide breaks down in the intestine before being absorbed. When administered to tissue, hydrogen peroxide solutions have low penetration. Distribution: The lungs, colon, thymus, liver, and kidney are among the target organs that hydrogen peroxide could possibly harm.

Metabolism: Glutathione Peroxide , an endogenous enzyme found in human tissue, reduces hydrogen peroxide. When it comes into touch with the enzyme catalase, which is present in most tissues and blood, it quickly decomposes into oxygen and water.

Excretion: NA

1. https://www.uptodate.com/contents/Hydrogen Peroxide -drug-information?search=Hydrogen Peroxide &source=panel_search_result&selectedTitle=1~148&usage_type=panel&kp_tab=drug_general&display_rank=1#F154338
2. https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/022352s017lbl.pdf
3. https://www.medicaid.nv.gov/Downloads/provider/Hydrogen Peroxide _2015-1215.pdf
4. https://www.mims.com/india/drug/info/Hydrogen Peroxide ?type=full&mtype=generic#mechanism-of-action