Povidone-iodine

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Povidone-iodine
abrasion using a cotton swab.
Clinical data
Trade namesBetadine, Wokadine, Pyodine, others
Other namespolyvidone iodine, iodopovidone
AHFS/Drugs.comConsumer Drug Information
License data
QG51AD01 (WHO)
Legal status
Legal status
  • US: OTC / Rx-only
Identifiers
  • 2-Pyrrolidinone, 1-ethenyl-, homopolymer
ECHA InfoCard
100.110.412 Edit this at Wikidata
Chemical and physical data
Formula(C6H9NO)n·xI
Molar massvariable
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Povidone-iodine (PVP-I), also known as iodopovidone, is an

wounds.[2] It may be applied to the skin as a liquid or a powder.[2]

Side effects include skin irritation and sometimes swelling.

thyroid problems or who are taking lithium.[2]

Povidone-iodine is a

microorganisms.[1]

Povidone-iodine came into commercial use in 1955.

over the counter.[6] It is sold under a number of brand names including Betadine.[2]

Medical uses

Wound area covered in povidone-iodine. Gauze has also been applied.

Povidone-iodine is a broad spectrum antiseptic for topical application in the treatment and prevention of

blisters. Povidone-iodine exhibits longer lasting antiseptic effects than tincture of iodine, due to its slow absorption via soft tissue, making it the choice for longer surgeries. Chlorhexidine is almost twice as effective in preventing infection after surgery with a similar to lower risk of adverse events,[7][8] and the combination of sodium hypochlorite and hypochlorous acid in very low concentration is significantly superior for wound healing.[9]

Consequently, PVP-I has found broad application in medicine as a surgical scrub; for pre- and post-operative skin cleansing; for the treatment and prevention of infections in

trichomonal or mixed infections. For these purposes PVP-I has been formulated at concentrations of 7.5–10.0% in solution, spray, surgical scrub, ointment, and swab dosage forms; however, use of 10% povidone-iodine though recommended, is infrequently used, as it is poorly accepted by health care workers and is excessively slow to dry.[10][11]

Because of these critical indications, only sterile povidone-iodine should be used in most cases. Non-sterile product can be appropriate in limited circumstances in which people have intact, healthy skin that will not be compromised or cut. The non-sterile form of Povidone iodine has a long history of intrinsic contamination with

Burkholderia cepacia (a.k.a. Pseudomonas cepacia), and other opportunistic pathogens. Its ability to harbor such microbes further underscores the importance of using sterile products in any clinical setting. Since these bacteria are resistant to povidone iodine, statements that bacteria do not develop resistance to PVP-I,[12] should be regarded with great caution: some bacteria are intrinsically resistant to a range of biocides including povidone-iodine.[13]

Antiseptic activity of PVP-I is because of free iodine (I2) and PVP-I only acts as carrier of I2 to the target cells. Most commonly used 10% PVP-I delivers about 1–3 ppm of I2 in a compound of more than 31,600 ppm of total iodine atoms. All the toxic and staining effects of PVP-I is due to the inactive iodine only.[citation needed]

Eyes

A

Herpes simplex).[15]

Pleurodesis

It is used in

pleura because of incessant pleural effusions). For this purpose, povidone-iodine is equally effective and safe as talc, and may be preferred because of easy availability and low cost.[16]

Alternatives

There is strong evidence that chlorhexidine and denatured alcohol used to clean skin prior to surgery is better than any formulation of povidone-iodine.[7]

Contraindications

PVP-I is contraindicated in people with

radioiodine, and in people with dermatitis herpetiformis[why?] (Duhring's disease).[17]

Side effects

The sensitization rate to the product is 0.7%.[18]

Interactions

The iodine in PVP-I reacts with hydrogen peroxide, silver, taurolidine and proteins such as enzymes, rendering them (and itself) ineffective. It also reacts with many mercury compounds, giving the corrosive compound mercury iodide, as well as with many metals, making it unsuitable for disinfecting metal piercings.[17]

Iodine is absorbed into the body to various degrees, depending on application area and condition of the skin. As such, it interacts with diagnostic tests of the thyroid gland such as radioiodine diagnostics, as well as with various diagnostic agents used on the urine and stool, for example Guaiacum resin.[17]

Structure

Structure of povidone-iodine complex.

Povidone-iodine is a

povidone (polyvinylpyrrolidone, PVP) and triiodide (I−
3).[19] It is synthesized by mixing the PVP polymer with iodine (I2), allowing the two to react.[20]

It is soluble in cold and mild-warm water,

Lugol's solution
.

Free iodine, slowly liberated from the povidone-iodine (PVP-I) complex in solution, kills cells through iodination of

viruses
. Slow release of iodine from the PVP-I complex in solution minimizes iodine toxicity towards mammalian cells.

PVP-I can be loaded into hydrogels, which can be based on carboxymethyl cellulose (CMC), poly(vinyl alcohol) (PVA), and gelatin, or on crosslinked polyacrylamide. These hydrogels can be used for wound dressing. The rate of release of the iodine in the PVP-I is heavily dependent on the hydrogel composition: it increases with more CMC/PVA and decreases with more gelatin.

History

Following the discovery of iodine by Bernard Courtois in 1811, it has been broadly used for the prevention and treatment of skin infections, as well as the treatment of wounds. Iodine has been recognized as an effective broad-spectrum bactericide, and is also effective against yeasts, molds, fungi, viruses, and protozoans. Drawbacks to its use in the form of aqueous solutions include irritation at the site of application, toxicity, and the staining of surrounding tissues. These deficiencies were overcome by the discovery and use of PVP-I, in which the iodine is carried in a complexed form and the concentration of free iodine is very low. The product thus serves as an iodophor.

PVP-I was discovered in 1955, at the Industrial Toxicology Laboratories in Philadelphia by H. A. Shelanski and M. V. Shelanski.[21] They carried out tests in vitro to demonstrate anti-bacterial activity, and found that the complex was less toxic in mice than tincture of iodine. Human clinical trials showed the product to be superior to other iodine formulations.[22]

Research

Schematic of povidone-iodine complex wrapping a single wall carbon nanotube (black).[23]

Povidone-iodine has found application in the field of nanomaterials.[24] A wound-healing application has been developed which employs a mat of single wall carbon nanotubes (SWNTs) coated in a monolayer of povidone-iodine.[23]

Research has previously found that the polymer polyvinylpyrrolidone (PVP, povidone) can coil around individual carbon nanotubes to make them water-soluble.[25]

See also

References

  1. ^
    ISBN 978-92-4-154765-9
    .
  2. ^
    OCLC 1031488649. Archived
    from the original on 22 February 2022.
  3. ^
    OCLC 899175361. Archived
    from the original on 2017-01-13.
  4. OCLC 62301847. Archived
    from the original on 2017-01-13.
  5. hdl:10665/345533
    . WHO/MHP/HPS/EML/2021.02.
  6. ^ "Povidone/iodine solution: Indications, Side Effects, Warnings - Drugs.com". www.drugs.com. Archived from the original on 13 January 2017. Retrieved 11 January 2017.
  7. ^
    PMID 32773627
    .
  8. S2CID 210950872
    .
  9. S2CID 3601026
    .
  10. S2CID 210193248
    .
  11. S2CID 46968733
    .
  12. PMID 9403248
    .
  13. PMID 19153076
    .
  14. PMC 6457593
    .
  15. ^ Najafi Bi R, Samani SM, Pishva N, Moheimani F (2003). "Formulation and Clinical Evaluation of Povidone-Iodine Ophthalmic Drop". Iranian Journal of Pharmaceuticical Research. 2 (3): 157–160.
  16. PMID 22561614
    .
  17. ^
    ISBN 978-3-85200-181-4. Archived
    from the original on 22 February 2022.
  18. PMID 9403263
    .
  19. S2CID 225472250. Archived
    from the original on 2022-02-22. Retrieved 2022-02-22.
  20. PMID 33362938
    . Three methods are used to obtain povidone–iodine: exposing the polymer to iodine vapors [36], mixing PVP and iodine solutions [37], and heating dry PVP and iodine samples at 80–90°C until the titrated iodine concentration is constant [35].
  21. ^ U.S. patent 2,739,922
  22. OCLC 318418088
    .
  23. ^
    doi:10.1016/j.carbon.2009.02.005. Archived from the original
    (PDF) on 2010-06-21.
  24. ISSN 0014-3057
    .
  25. PMID 17663555
    .

Further reading

External links

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