Drugs List

Therapeutic Indications

Uses

Skin disinfection
Surgical scrub

Contraindications

Neonates
Breastfeeding
Pregnancy

Precautions and Warnings

Elderly
Renal impairment
Thyroid dysfunction

Avoid regular use in thyroid disease
Not all available brands are licensed for all indications
Avoid application to broken skin
Avoid application to large wounds or severe burns
Monitor renal function during prolonged/high dose therapy
Monitor thyroid function where clinically indicated
Contamination may interfere with tests for occult blood in urine/faeces
Systemic absorption may interfere with thyroid function tests
Discontinue if irritation or sensitisation occur
Stains clothes and skin

Pregnancy and Lactation

Pregnancy

Povidone-iodine is contraindicated in pregnancy.

Iodine readily crosses the placenta (Briggs, 2011) and when used as a topical disinfectant on intact skin or wounds transfer to the foetus must be assumed (Schaefer, 2007). If iodine is used close to term, transient hypothyroidism can result and if used for prolonged periods, foetal goitre. Consideration should be given to altered thyroid status and potential effects on central nervous system development although retrospective evaluation of infants following vaginal douching showed no indication of teratogenic effect (Schaefer, 2007).

It should also be noted that povidone-iodine may affect the newborn thyroid function screening tests.

The manufacturer advises that regular use should be avoided and that caution should otherwise be used.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Povidone-iodine is contraindicated in breastfeeding.

Iodine is stated by some authors to be absorbed little though intact adult skin (Hale, 2010) whilst by others that it is significantly absorbed through skin though less well than via wounds or mucous membranes (Briggs, 2011).

Iodine is significantly concentrated in breast milk (Schaefer, 2007 and Briggs, 2011) and use of iodine containing disinfectants over wide areas could lead to relatively high levels of free iodine in milk (Schaefer, 2007). Use of povidone-iodine near term and during breastfeeding may result in hypothyroidism in breastfed infants and has resulted in a higher recall rate for screening for congenital hypothyroidism (Briggs, 2011).

It should also be noted that povidone-iodine may affect the newborn thyroid function screening tests.

The manufacturer advises that regular use should be avoided and that caution should otherwise be used.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Hypernatraemia
Hypersensitivity reactions
Impaired renal function
Metabolic acidosis
Stains skin brown
Thyroid abnormalities

Presentation

Topical formulation of povidone-iodine

Drugs List

Therapeutic Indications

Uses

Skin disinfection
Surgical scrub

Dosage

Adults

Elderly

Children

Contraindications

Neonates
Breastfeeding
Pregnancy

Precautions and Warnings

Elderly
Renal impairment
Thyroid dysfunction

Avoid regular use in thyroid disease
Not all available brands are licensed for all indications
Avoid application to broken skin
Avoid application to large wounds or severe burns
Monitor renal function during prolonged/high dose therapy
Monitor thyroid function where clinically indicated
Contamination may interfere with tests for occult blood in urine/faeces
Systemic absorption may interfere with thyroid function tests
Discontinue if irritation or sensitisation occur
Stains clothes and skin

Pregnancy and Lactation

Pregnancy

Povidone-iodine is contraindicated in pregnancy.

Iodine readily crosses the placenta (Briggs, 2011) and when used as a topical disinfectant on intact skin or wounds transfer to the foetus must be assumed (Schaefer, 2007). If iodine is used close to term, transient hypothyroidism can result and if used for prolonged periods, foetal goitre. Consideration should be given to altered thyroid status and potential effects on central nervous system development although retrospective evaluation of infants following vaginal douching showed no indication of teratogenic effect (Schaefer, 2007).

It should also be noted that povidone-iodine may affect the newborn thyroid function screening tests.

The manufacturer advises that regular use should be avoided and that caution should otherwise be used.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Povidone-iodine is contraindicated in breastfeeding.

Iodine is stated by some authors to be absorbed little though intact adult skin (Hale, 2010) whilst by others that it is significantly absorbed through skin though less well than via wounds or mucous membranes (Briggs, 2011).

Iodine is significantly concentrated in breast milk (Schaefer, 2007 and Briggs, 2011) and use of iodine containing disinfectants over wide areas could lead to relatively high levels of free iodine in milk (Schaefer, 2007). Use of povidone-iodine near term and during breastfeeding may result in hypothyroidism in breastfed infants and has resulted in a higher recall rate for screening for congenital hypothyroidism (Briggs, 2011).

It should also be noted that povidone-iodine may affect the newborn thyroid function screening tests.

The manufacturer advises that regular use should be avoided and that caution should otherwise be used.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Hypernatraemia
Hypersensitivity reactions
Impaired renal function
Metabolic acidosis
Stains skin brown
Thyroid abnormalities

Effects on Laboratory Tests

If contamination of a sample occurs whilst using povidone-iodine aqueous solution 10%, a false positive may occur when testing for the presence of blood, for example, faecal occult blood or for blood in the urine.

Systemic absorption of iodine may interfere with thyroid function tests.

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: March 2015.

Reference Sources

Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

Joint Formulary Committee. British National Formulary(online) London: BMJ Group and Pharmaceutical Press Accessed on 24 January 2015.

Martindale: The Complete Drug Reference (online) London: Brayfield A (ed). Pharmaceutical Press Accessed on 24 January 2015.

Medications and Mothers' Milk, 14th Edition (2010) Hale, T. Hale Publishing, Amarillo, Texas.

Paediatric Formulary Committee. BNF for Children (online) London: BMJ Group, Pharmaceutical Press, and RCPCH Publications Accessed on 24 January 2015.

Summary of Product Characteristics: Videne alcoholic tincture. Ecolab Ltd. Revised January 2015.
Summary of Product Characteristics: Videne surgical scrub. Ecolab Ltd. Revised January 2015.

US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Povidone-iodine Last revised: 7 September 2013
Last accessed: 24 January 2015