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Hydrogen peroxide: Drug information

Hydrogen peroxide: Drug information
(For additional information see "Hydrogen peroxide: Pediatric drug information" and see "Hydrogen peroxide: Patient drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: US
  • Eskata;
  • GoodSense Hydrogen Peroxide [OTC];
  • Medi-First Hydrogen Peroxide [OTC];
  • Perox-A-Mint [OTC];
  • Peroxyl Spot Treatment [OTC]
Pharmacologic Category
  • Antibacterial, Topical;
  • Antibiotic, Oral Rinse
Dosing: Adult

Note: Not all available products or formulations are represented in dosing; also refer to manufacturer's labeling.

Antiseptic; minor dermal abrasion

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

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

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

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

(For additional information see "Hydrogen peroxide: Pediatric drug information")

Antiseptic; minor dermal abrasion

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

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

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

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

>10%:

Dermatologic: Erythema (99%), stinging of the skin (97%), desquamation (90%), crusted skin (81%), pruritus (58%), hyperpigmentation (39%), skin vesicle (24%), hypopigmentation (19%), severe erythema (19%), skin erosion (15%)

Local: Skin edema (91%)

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

<1%, postmarketing, and/or case reports: Arthropathy (crepitus), eyelid edema, herpes zoster infection

Contraindications

OTC labeling: Use in the eyes or over large areas of the body; use longer than a week.

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

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.

• 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.

Warnings: Additional Pediatric Considerations

Some dosage forms may contain propylene glycol; in neonates large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP 1997; Shehab 2009).

Dosage Forms: US

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:

Eskata: 40% (1 ea) [contains isopropyl alcohol]

GoodSense Hydrogen Peroxide: 3% (236 mL, 473 mL, 946 mL)

Medi-First Hydrogen Peroxide: 3% (59.1 mL)

Generic: 3% (1 mL, 30 mL [DSC], 118 mL [DSC], 473 mL, 480 mL, 946 mL, 3840 mL)

Solution, Mouth/Throat:

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

Generic Equivalent Available: US

May be product dependent

Pricing: US

Gel (Peroxyl Spot Treatment Mouth/Throat)

1.5% (per gram): $0.29

Solution (Eskata External)

40% (per each): $156.00

Solution (Hydrogen Peroxide External)

3% (per mL): $0.00

Solution (Medi-First Hydrogen Peroxide External)

3% (per mL): $0.05

Solution (Perox-A-Mint Mouth/Throat)

1.5% (per mL): $0.04

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Administration: Adult

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.

Administration: Pediatric

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.

Topical: Oral application: For topical use only; do not swallow. Children under 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

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 raised seborrheic keratoses.

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

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

Mechanism of Action

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.

Pharmacokinetics (Adult Data Unless Noted)

Duration of action: Only while bubbling action occurs

Absorption: None

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Aosept | Hydrogen peroxid | Hydrogen Peroxide Bell | Hydrogen Peroxide Rusco | Oxysept 1 step;
  • (AR) Argentina: Agua oxigenada | Aosept plus | Aosept plus hydraglyde | Oxysept comfort;
  • (AU) Australia: Ao sept | Cm hydrogen perox | Colgate peroxyl | Gold cross hydrogen peroxide | Oxysept 1 step;
  • (BG) Bulgaria: Hydrogen peroxid;
  • (BR) Brazil: Agua oxigenada | Aosept | Otiblock | Oxysept 1 step;
  • (CH) Switzerland: Aosept;
  • (CL) Chile: Agua oxigenada;
  • (CO) Colombia: Agua oxigenada | Aosept | Dioxogen;
  • (CZ) Czech Republic: Oxysept 1 step | Peroxid vodiku;
  • (DE) Germany: Wasserstoffperoxid | Wasserstoffperoxidloesung 3dab 10 | Wasserstoffperoxyd;
  • (EC) Ecuador: Aosept plus;
  • (EE) Estonia: Hydrogenii perox | Hydrogenii perox. | Hydrogenii Peroxyd | Hydrogenii peroxydi | Vesinikulihapendi;
  • (ES) Spain: Agua oxigenada | Agua oxigenada betafar | Agua oxigenada cinfa | Agua oxigenada cuve | Agua Oxigenada Foret | Agua Oxigenada Interapotek | Agua oxigenada viviar | Oximen;
  • (FR) France: Aosept | Aosept plus | Dentex | Eau oxygenee | Eau oxygenee gilbert | Peroxol 1;
  • (GB) United Kingdom: Colgate peroxyl | Peroxyl;
  • (GR) Greece: Aosept | Lensept | Oxysept 1 step | Peroxyl;
  • (IL) Israel: Aosept | Oxysept 1 step | Titmus;
  • (IN) India: Oramint Px;
  • (IT) Italy: Oragard;
  • (JO) Jordan: Aosept | Aosept plus | Titmus;
  • (JP) Japan: Oxydol | Oxydol merck hoei | Oxydol sioe | Oxyfull sankyo | Puchic oxydol;
  • (KW) Kuwait: Otiblock;
  • (LB) Lebanon: Aosept;
  • (LV) Latvia: Hydrogenii perox. | Hydrogenium peroxy | Udenraza peroksida rff;
  • (MX) Mexico: Agua oxigenada azteca | Agua oxigenada jaloma | Aosept;
  • (MY) Malaysia: Aosept plus | Otiblock;
  • (NG) Nigeria: De shalom hydrogen peroxide | Ige hydrogen peroxide solution | Novapharm hydrogen peroxide;
  • (NL) Netherlands: Waterstofperoxide Mondspoeling;
  • (NO) Norway: Hydrogen perox life | Hydrogenperoksid NAF;
  • (NZ) New Zealand: Aosept | Aosept plus lens;
  • (PE) Peru: Agua oxigenada | Aosept;
  • (PL) Poland: Hydrogenium peroxy | Peroxygel | Peroxyl | Woda utleniona;
  • (PR) Puerto Rico: Aosept | Peroxyl | Zim's crack creme hydrogen peroxide;
  • (PY) Paraguay: Agua oxigenada 10 volumenes guayaki;
  • (QA) Qatar: Hay Oxide | Mexo;
  • (RU) Russian Federation: Aosept | Heferol | Hydrogen perox bufus | Hydrogen peroxide bufus | Hydrogen peroxyde;
  • (SA) Saudi Arabia: Aosept | Otiblock;
  • (SI) Slovenia: Aosept;
  • (SK) Slovakia: Peroxid vodika;
  • (TH) Thailand: Hydrogen;
  • (TR) Turkey: Aosept | Aosept plus | Aosept starter set | Easysept | Oxysept 1 step;
  • (TW) Taiwan: Oxydol | Oxydolum;
  • (UA) Ukraine: Hydrogen peroxide vishpha | Hydrogen peroxydum | Peroxygel;
  • (UY) Uruguay: Agua oxigenada;
  • (VE) Venezuela, Bolivarian Republic of: Agua oxigenada | Aosept | Dioxogen;
  • (ZA) South Africa: Aosept plus hydraglyde | Aosept snowbird | Evaqwax | Oxysept 1 step | Peroxide
  1. 3% Hydrogen Peroxide Spray [prescribing information]. Deerfield, IL: Walgreen Co; January 2015.
  2. American Academy of Pediatrics Committee on Drugs. "Inactive" ingredients in pharmaceutical products: update (subject review). Pediatrics. 1997;99(2):268-278. [PubMed 9024461]
  3. Colgate Peroxyl Mouth Sore Rinse (hydrogen peroxide) [prescribing information]. New York, NY: Colgate Palmolive Company; received June 2022.
  4. Eskata (hydrogen peroxide) [prescribing information]. Wayne, PA: Aclaris Therapeutics Inc; February 2019.
  5. Food and Drug Administration (FDA). FDA warns consumers against drinking high-strength hydrogen peroxide for medicinal use. Ingestion can lead to serious health risks and death. July 27, 2006.
  6. Goodsense Hydrogen Peroxide [prescribing information]. Peachtree City, GA: Geiss, Destin, and Dunn, Inc; received June 2022.
  7. Perox-A-Mint Solution (hydrogen peroxide) [prescribing information]. Cary, IL: Sage Products, Inc; received June 2022.
  8. Shehab N, Lewis CL, Streetman DD, et al. Exposure to the pharmaceutical excipients benzyl alcohol and propylene glycol among critically ill neonates. Pediatr Crit Care Med. 2009;10(2):256-259. [PubMed 19188870]
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