Iodine (medical use)

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Iodine is a chemical element with many uses in medicine, depending on the form. Elemental iodine and iodophors are topical antiseptics. [2] Iodine, in non-elemental form, functions as an essential nutrient in human biology (see iodine in biology). [3] Organic compounds containing iodine are also useful iodinated contrast agents in X-ray imaging. [4]

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Common side effects when applied to the skin include irritation and discoloration. [2] Supplementation during pregnancy is recommended in regions where deficiency is common, otherwise it is not recommended. [1] Iodine is an essential trace element. [1]

In 1811, Bernard Courtois isolated iodine from seaweed while in 1820 Jean-Francois Coindet linked iodine intake to goiter size. [5] It initially came into use as a disinfectant and a treatment for goiter. [6] [7] The following forms of iodine are found on the World Health Organization's List of Essential Medicines: [8]

In addition, table salt with non-elemental iodine, known as iodized salt, is available in more than 110 countries. [9]

Forms and formulations

Elemental iodine

Iodine, elemental
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Formula I2

Elemental iodine is used as an antiseptic either as the element, or as the water-soluble triiodide anion I3− generated in situ by adding iodide to poorly water-soluble elemental iodine (the reverse chemical reaction makes some free elemental iodine available for antisepsis). [1]

In the alternative, iodine may be produced from iodophors, which contain iodine complexed with a solubilizing agent (the iodide ion may be thought of loosely as the iodophor in triiodide water solutions). Examples of such preparations include: [11]

The antimicrobial action of iodine is quick and works at low concentrations, and thus it is used in operating theatres. [13] Its specific mode of action is unknown. It penetrates into microorganisms and attacks particular amino acids (such as cysteine and methionine), nucleotides, and fatty acids, ultimately resulting in cell death. It also has an antiviral action, but nonlipid viruses and parvoviruses are less sensitive than lipid enveloped viruses. Iodine probably attacks surface proteins of enveloped viruses, and it may also destabilise membrane fatty acids by reacting with unsaturated carbon bonds. [14]

Iodine-containing salts

As a nutrient, iodine enters cells as the iodide ion; [15] iodide is also the form of iodine found food such as kelp. [16]

The form of iodide salt most commonly used medically is potassium iodide. At low doses, it is one of the options for making iodized salt, along with the more stable potassium iodate. A saturated solution of potassium iodide is used to treat acute thyrotoxicosis. It is also used to block uptake of iodine-131 in the thyroid gland (see isotopes section above), when this isotope is used as part of radiopharmaceuticals (such as iobenguane) that are not targeted to the thyroid or thyroid-type tissues. [17] [18]

Iodine-131 (usually as iodide) is a component of nuclear fallout, and is particularly dangerous owing to the thyroid gland's propensity to concentrate ingested iodine and retain it for periods longer than this isotope's radiological half-life of eight days. For this reason, people at risk of exposure to environmental radioactive iodine (iodine-131) in fallout may be instructed to take non-radioactive potassium iodide tablets. The typical adult dose is one 130 mg tablet per 24 hours, supplying 100 mg (100,000 micrograms) of ionic iodine. (The typical daily dose of iodine for normal health is of order 100 micrograms; see "Dietary Intake" below.) Ingestion of this large dose of non-radioactive iodine minimises the uptake of radioactive iodine by the thyroid gland. [19]

Before the advent of organic chelating agents, salts of iodide were given orally in the treatment of lead or mercury poisoning, such as heavily popularized by Louis Melsens and many nineteenth and early twentieth century doctors. [20] [21]

Organoiodine compounds

Diatrizoic acid, an iodine-containing radiocontrast agent Diatrizoic acid.svg
Diatrizoic acid, an iodine-containing radiocontrast agent

As an element with high electron density and atomic number, iodine absorbs X-rays weaker than 33.3 keV due to the photoelectric effect of the innermost electrons. [4] Organoiodine compounds are used with intravenous injection as X-ray radiocontrast agents. This application is often in conjunction with advanced X-ray techniques such as angiography and CT scanning. At present, all water-soluble radiocontrast agents rely on iodine-containing compounds.

Iodized oil , made by reacting ether esters of fatty acids form vegetable oil with hydroiodic acid, is another important organoiodine preparation. As an iodine supplement, it is given by mouth once per year to prevent endemic goitre in remote communities. [1] [22] It is also used as a non-water-soluble radiocontrast. [23]

Other organoiodine drugs include:

See also

Related Research Articles

<span class="mw-page-title-main">Iodine</span> Chemical element with atomic number 53 (I)

Iodine is a chemical element; it has symbol I and atomic number 53. The heaviest of the stable halogens, it exists at standard conditions as a semi-lustrous, non-metallic solid that melts to form a deep violet liquid at 114 °C (237 °F), and boils to a violet gas at 184 °C (363 °F). The element was discovered by the French chemist Bernard Courtois in 1811 and was named two years later by Joseph Louis Gay-Lussac, after the Ancient Greek Ιώδης, meaning 'violet'.

<span class="mw-page-title-main">Tincture of iodine</span> Antiseptic solution rubbed on skin before surgical operations

Tincture of iodine, iodine tincture, or weak iodine solution is an antiseptic. It is usually 2 to 3% elemental iodine, along with potassium iodide or sodium iodide, dissolved in a mixture of ethanol and water. Tincture solutions are characterized by the presence of alcohol. It was used from 1908 in pre-operative skin preparation by Italian surgeon Antonio Grossich.

An iodide ion is the ion I−. Compounds with iodine in formal oxidation state −1 are called iodides. In everyday life, iodide is most commonly encountered as a component of iodized salt, which many governments mandate. Worldwide, iodine deficiency affects two billion people and is the leading preventable cause of intellectual disability.

<span class="mw-page-title-main">Nuclear fission product</span> Atoms or particles produced by nuclear fission

Nuclear fission products are the atomic fragments left after a large atomic nucleus undergoes nuclear fission. Typically, a large nucleus like that of uranium fissions by splitting into two smaller nuclei, along with a few neutrons, the release of heat energy, and gamma rays. The two smaller nuclei are the fission products..

Radiocontrast agents are substances used to enhance the visibility of internal structures in X-ray-based imaging techniques such as computed tomography, projectional radiography, and fluoroscopy. Radiocontrast agents are typically iodine, or more rarely barium sulfate. The contrast agents absorb external X-rays, resulting in decreased exposure on the X-ray detector. This is different from radiopharmaceuticals used in nuclear medicine which emit radiation.

<span class="mw-page-title-main">Potassium iodide</span> Ionic compound (KI)

Potassium iodide is a chemical compound, medication, and dietary supplement. It is a medication used for treating hyperthyroidism, in radiation emergencies, and for protecting the thyroid gland when certain types of radiopharmaceuticals are used. In the third world it is also used for treating skin sporotrichosis and phycomycosis. It is a supplement used by people with low dietary intake of iodine. It is administered orally.

<span class="mw-page-title-main">Potassium perchlorate</span> Chemical compound

Potassium perchlorate is the inorganic salt with the chemical formula KClO4. Like other perchlorates, this salt is a strong oxidizer when the solid is heated at high temperature although it usually reacts very slowly in solution with reducing agents or organic substances. This colorless crystalline solid is a common oxidizer used in fireworks, ammunition percussion caps, explosive primers, and is used variously in propellants, flash compositions, stars, and sparklers. It has been used as a solid rocket propellant, although in that application it has mostly been replaced by the more performant ammonium perchlorate.

<span class="mw-page-title-main">Iodised salt</span> Table salt preparation with iodide salts added

Iodised salt is table salt mixed with a minute amount of various salts of the element iodine. The ingestion of iodine prevents iodine deficiency. Worldwide, iodine deficiency affects about two billion people and is the leading preventable cause of intellectual and developmental disabilities. Deficiency also causes thyroid gland problems, including endemic goitre. In many countries, iodine deficiency is a major public health problem that can be cheaply addressed by purposely adding small amounts of iodine to the sodium chloride salt.

<span class="mw-page-title-main">Iodinated contrast</span> Substance to enhance X-ray imaging

Iodinated contrast is a form of water-soluble, intravenous radiocontrast agent containing iodine, which enhances the visibility of vascular structures and organs during radiographic procedures. Some pathologies, such as cancer, have particularly improved visibility with iodinated contrast.

<span class="mw-page-title-main">Lugol's iodine</span> Aqueous solution of iodine and potassium iodide

Lugol's iodine, also known as aqueous iodine and strong iodine solution, is a solution of potassium iodide with iodine in water. It is a medication and disinfectant used for a number of purposes. Taken by mouth it is used to treat thyrotoxicosis until surgery can be carried out, protect the thyroid gland from radioactive iodine, and to treat iodine deficiency. When applied to the cervix it is used to help in screening for cervical cancer. As a disinfectant it may be applied to small wounds such as a needle stick injury. A small amount may also be used for emergency disinfection of drinking water.

<span class="mw-page-title-main">Povidone-iodine</span> Antiseptic solution

Povidone-iodine (PVP-I), also known as iodopovidone, is an antiseptic used for skin disinfection before and after surgery. It may be used both to disinfect the hands of healthcare providers and the skin of the person they are caring for. It may also be used for minor wounds. It may be applied to the skin as a liquid, an ointment or a powder.

<span class="mw-page-title-main">Sodium iodide</span> Chemical compound

Sodium iodide (chemical formula NaI) is an ionic compound formed from the chemical reaction of sodium metal and iodine. Under standard conditions, it is a white, water-soluble solid comprising a 1:1 mix of sodium cations (Na+) and iodide anions (I−) in a crystal lattice. It is used mainly as a nutritional supplement and in organic chemistry. It is produced industrially as the salt formed when acidic iodides react with sodium hydroxide. It is a chaotropic salt.

<span class="mw-page-title-main">Isotopes of iodine</span> Nuclides with atomic number of 53 but with different mass numbers

There are 37 known isotopes of iodine (53I) from 108I to 144I; all undergo radioactive decay except 127I, which is stable. Iodine is thus a monoisotopic element.

Iodized oil, also known as ethiodized oil, brand name Lipiodol, is a medication derived from poppyseed oil and iodine. When given by injection, it is a radio-opaque contrast agent that is used to outline structures in radiological investigations. When given orally or by intramuscular injection once or twice a year, it prevents endemic goitre in remote communities. It has an additional use in gastric variceal obliteration as a dilutant that does not affect polymerization of cyanoacrylate.

<span class="mw-page-title-main">Potassium iodate</span> Chemical compound

Potassium iodate (KIO3) is an ionic inorganic compound with the formula KIO3. It is a white salt that is soluble in water.

Iodine compounds are compounds containing the element iodine. Iodine can form compounds using multiple oxidation states. Iodine is quite reactive, but it is much less reactive than the other halogens. For example, while chlorine gas will halogenate carbon monoxide, nitric oxide, and sulfur dioxide, iodine will not do so. Furthermore, iodination of metals tends to result in lower oxidation states than chlorination or bromination; for example, rhenium metal reacts with chlorine to form rhenium hexachloride, but with bromine it forms only rhenium pentabromide and iodine can achieve only rhenium tetraiodide. By the same token, however, since iodine has the lowest ionisation energy among the halogens and is the most easily oxidised of them, it has a more significant cationic chemistry and its higher oxidation states are rather more stable than those of bromine and chlorine, for example in iodine heptafluoride.

<span class="mw-page-title-main">Iobitridol</span> Pharmaceutical drug

Iobitridol is a pharmaceutical drug used as an iodine-based radiocontrast agent in X-ray imaging. It is injected into blood vessels, joints, or body cavities such as the uterus, and filtered out by the kidneys. Its most common adverse effect is nausea. Severe allergic reactions are rare.

<span class="mw-page-title-main">Ioxaglic acid</span> Chemical compound

Ioxaglic acid is pharmaceutical drug used as an iodinated contrast medium for X-ray imaging. It has low osmolality, typically resulting in fewer side effects than high-osmolality media. It is manufactured by Guerbet, but marketing in the US has been discontinued. As of 2021, it may still be available in some European countries.

Organoiodine chemistry is the study of the synthesis and properties of organoiodine compounds, or organoiodides, organic compounds that contain one or more carbon–iodine bonds. They occur widely in organic chemistry, but are relatively rare in nature. The thyroxine hormones are organoiodine compounds that are required for health and the reason for government-mandated iodization of salt.

<span class="mw-page-title-main">Iodine in biology</span> Use of Iodine by organisms

Iodine is an essential trace element in biological systems. It has the distinction of being the heaviest element commonly needed by living organisms as well as the second-heaviest known to be used by any form of life. It is a component of biochemical pathways in organisms from all biological kingdoms, suggesting its fundamental significance throughout the evolutionary history of life.

References

    1. 1 2 3 4 5 World Health Organization (2009). Stuart MC, Kouimtzi M, Hill SR (eds.). WHO Model Formulary 2008. World Health Organization. p. 499. hdl: 10665/44053 . ISBN   9789241547659.
    2. 1 2 "Iodine". The American Society of Health-System Pharmacists. Archived from the original on 13 January 2017. Retrieved 8 January 2017.– This article deals with iodine for topical use. The listed brand names (Iodoflex, Iodosorb) are more appropriately attributed to cadexomer iodine, ATC code D03AX01.
    3. ↑ "Iodine Deficiency". American Thyroid Association. Archived from the original on 18 November 2022. Retrieved 18 November 2022.
    4. 1 2 Lancaster JL. "Chapter 4: Physical Determinants of Contrast" (PDF). Physics of Medical X-Ray Imaging. The University of Texas Health Science Center. Archived from the original (PDF) on 10 October 2015.
    5. ↑ Leung AM, Braverman LE, Pearce EN (November 2012). "History of U.S. iodine fortification and supplementation". Nutrients. 4 (11): 1740–1746. doi: 10.3390/nu4111740 . PMC   3509517 . PMID   23201844.
    6. ↑ Starke JA (2009). "14. Application of Iodine Water Purification Tablets: Iodine's Efficacy against Cryptosporidium parvum.". In Preedy VR, Burrow GN, Watson RR (eds.). Comprehensive Handbook of Iodine: Nutritional, Biochemical, Pathological and Therapeutic Aspects. Academic Press. p. 135. ISBN   9780080920863. Archived from the original on 12 August 2017.
    7. ↑ Sneader W (2005). "Legacy of the Past". Drug Discovery: A History. John Wiley & Sons. ISBN   9780471899792. Archived from the original on 13 January 2017.
    8. 1 2 3 4 5 6 7 World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl: 10665/325771 . WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
    9. ↑ Wesley AS, Horton S (2010). "Economics of Food Fortification". In Watson RR, Gerald JK, Preedy VR (eds.). Nutrients, Dietary Supplements, and Nutriceuticals: Cost Analysis Versus Clinical Benefits. Springer Science & Business Media. p. 37. ISBN   9781607613084. Archived from the original on 13 January 2017.
    10. ↑ "Diagnostic agents". Health Canada . 8 May 2018. Retrieved 13 April 2024.
    11. ↑ Block SS (2001). Disinfection, sterilization, and preservation. Hagerstwon, MD: Lippincott Williams & Wilkins. p. 159. ISBN   978-0-683-30740-5.
    12. ↑ Köntös Z (9 July 2021). "Efficacy of "Essential Iodine Drops" against Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2)". PLOS ONE. 16 (7): e0254341. Bibcode:2021PLoSO..1654341K. doi: 10.1371/journal.pone.0254341 . PMC   8270147 . PMID   34242340.
    13. ↑ Patwardhan N, Kelkar U (2011). "Disinfection, sterilization and operation theater guidelines for dermatosurgical practitioners in India". Indian Journal of Dermatology, Venereology and Leprology. 77 (1): 83–93. doi: 10.4103/0378-6323.74965 . PMID   21220895.
    14. ↑ McDonnell G, Russell AD (January 1999). "Antiseptics and disinfectants: activity, action, and resistance". Clinical Microbiology Reviews. 12 (1): 147–179. doi:10.1128/CMR.12.1.147. PMC   88911 . PMID   9880479.
    15. ↑ Eskin BA, Grotkowski CE, Connolly CP, Ghent WR (July 1995). "Different tissue responses for iodine and iodide in rat thyroid and mammary glands". Biological Trace Element Research. 49 (1): 9–19. doi:10.1007/BF02788999. PMID   7577324. S2CID   24230708.
    16. ↑ Nagataki S, Shizume K, Nakao K (May 1967). "Thyroid function in chronic excess iodide ingestion: comparison of thyroidal absolute iodine uptake and degradation of thyroxine in euthyroid Japanese subjects". The Journal of Clinical Endocrinology and Metabolism. 27 (5): 638–647. doi:10.1210/jcem-27-5-638. PMID   4164900.
    17. ↑ "Solubility of KI in water". Hazard.com. 21 April 1998. Retrieved 21 January 2013.
    18. ↑ "EANM procedure guidelines for 131I-meta-iodobenzylguanidine (131I-mIBG) therapy" (PDF). 17 June 2009. Archived from the original (PDF) on 17 June 2009.
    19. ↑ "CDC Radiation Emergencies", U.S. Centers for Disease Control, 11 October 2006, accessed 14 November 2010.
    20. ↑ "Sur l'emploi de l'iodure de potassium pour combattre les affections saturnines et mercurielles", in Annales de chimie et de physique, t. 26, 3e série, 1849.
    21. ↑ "On the Employment of Iodide of Potassium as a Remedy for the Affections Caused by Lead and Mercury", in Br Foreign Med Chir Rev. 1853 Jan; 11(21): 201–224.
    22. ↑ Ingenbleek Y, Jung L, Férard G, Bordet F, Goncalves AM, Dechoux L (November 1997). "Iodised rapeseed oil for eradication of severe endemic goitre". Lancet. 350 (9090): 1542–1545. doi:10.1016/s0140-6736(97)02427-6. PMID   9388412.
    23. ↑ Olliff J, Riley P (2012). "Radiological contrast agents and radiopharmaceuticals". Side Effects of Drugs Annual. 34: 749–760. doi:10.1016/b978-0-444-59499-0.00046-5. ISBN   978-0-444-59499-0.
    24. ↑ Petty TL (January 1990). "The National Mucolytic Study. Results of a randomized, double-blind, placebo-controlled study of iodinated glycerol in chronic obstructive bronchitis". Chest. 97 (1): 75–83. doi:10.1378/chest.97.1.75. PMID   2403903.
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