Lugol's iodine

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Lugol's iodine
2%25 Lugol's Iodine Solution Drops Thyroid Support Supplement 2oz.jpg
2% Lugol's iodine solution
Clinical data
Other namesPotassium triiodide, Lugol's solution, aqueous iodine, strong iodine solution [1]
AHFS/Drugs.com Monograph
License data
Routes of
administration 		topical, by mouth
Identifiers
CAS Number
DrugBank
UNII
CompTox Dashboard (EPA)
Chemical and physical data
Formula I3K
Molar mass 419.812

Lugol's iodine, also known as aqueous iodine and strong iodine solution, is a solution of potassium iodide with iodine in water. [2] It is a medication and disinfectant used for a number of purposes. [3] [4] 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. [4] [5] When applied to the cervix it is used to help in screening for cervical cancer. [6] As a disinfectant it may be applied to small wounds such as a needle stick injury. [3] A small amount may also be used for emergency disinfection of drinking water. [7]

Contents

Side effects may include allergic reactions, headache, vomiting, and conjunctivitis. [4] [1] Long term use may result in trouble sleeping and depression. [4] It should not typically be used during pregnancy or breastfeeding. [4] Lugol's iodine is a liquid made up of two parts potassium iodide for every one part elemental iodine in water. [8]

Lugol's iodine was first made in 1829 by the French physician Jean Lugol. [7] [8] It is on the World Health Organization's List of Essential Medicines. [9] [10] Lugol's iodine is available as a generic medication and over the counter. [1] Lugol's solution is available in different strengths of iodine. Large volumes of concentrations more than 2.2% may be subject to regulation. [11]

Uses

Medical uses

Preoperative administration of Lugol's solution decreases intraoperative blood loss during thyroidectomy in patients with Graves' disease. [12] However, it appears ineffective in patients who are already euthyroid on anti-thyroid drugs and levothyroxine. [13]

Science

Outdated uses

Up until early 1970s, it was often recommended for use in victims of rape in order to avoid pregnancy. The idea stemmed from the fact that, in the laboratory, Lugol's iodine appeared to kill sperm cells even in such great dilutions as 1:32. Thus it was thought that an intrauterine application of Lugol's iodine, immediately after the event, would help avoid pregnancy. [19]

Side effects

Because it contains free iodine, Lugol's solution at 2% or 5% concentration without dilution is irritating and destructive to mucosa, such as the lining of the esophagus and stomach. Doses of 10 mL of undiluted 5% solution have been reported to cause gastric lesions when used in endoscopy. [20] The LD50 for 5% Iodine is 14,000 mg/kg (14 g/kg) in rats, and 22,000 mg/kg (22 g/kg) in mice. [21]

The World Health Organization classifies substances taken orally with an LD50 of 5–50 mg/kg as the second highest toxicity class, Class Ib (Highly Hazardous). [22] The Global Harmonized System of Classification and Labeling of Chemicals categorizes this as Category 2 with a hazard statement "Fatal if swallowed". [23] Potassium iodide is not considered hazardous. [24]

Mechanism of action

The above uses and effects are consequences of the fact that the solution is a source of effectively free elemental iodine, which is readily generated from the equilibrium between elemental iodine molecules and polyiodide ions in the solution.

History

It was historically used as a first-line treatment for hyperthyroidism, as the administration of pharmacologic amounts of iodine leads to temporary inhibition of iodine organification in the thyroid gland, caused by phenomena including the Wolff–Chaikoff effect and the Plummer effect. However it is not used to treat certain autoimmune causes of thyroid disease as iodine-induced blockade of iodine organification may result in hypothyroidism. They are not considered as a first line therapy because of possible induction of resistant hyperthyroidism but may be considered as an adjuvant therapy when used together with other hyperthyroidism medications.

Lugol's iodine has been used traditionally to replenish iodine deficiency. Because of its wide availability as a drinking-water decontaminant, and high content of potassium iodide, emergency use of it was at first recommended to the Polish government in 1986, after the Chernobyl disaster to replace and block any intake of radioactive 131
I , even though it was known to be a non-optimal agent, due to its somewhat toxic free-iodine content. [25] Other sources state that pure potassium iodide solution in water (SSKI) was eventually used for most of the thyroid protection after this accident. [26] There is "strong scientific evidence" for potassium iodide thyroid protection to help prevent thyroid cancer. Potassium iodide does not provide immediate protection but can be a component of a general strategy in a radiation emergency. [27] [ failed verification ]

Historically, Lugol's iodine solution has been widely available and used for a number of health problems with some precautions. [28] Lugol's is sometimes prescribed in a variety of alternative medical treatments. [29] [30] Only since the end of the Cold War has the compound become subject to national regulation in the English-speaking world.[ citation needed ]

Society and culture

Regulation

Until 2007, in the United States, Lugol's solution was unregulated and available over the counter as a general reagent, an antiseptic, a preservative, [31] or as a medicament for human or veterinary application.

Since 1 August 2007, the DEA regulates all iodine solutions containing greater than 2.2% elemental iodine as a List I precursor because they may potentially be used in the illicit production of methamphetamine. [11] Transactions of up to one fluid ounce (30 ml) of Lugol's solution are exempt from this regulation.

Formula and manufacture

Nominal concentrationIodine (I2)
[mg/100μL [32] ]		Potassium iodide (KI)
[mg/100μL [32] ]		Total iodine
[mg/100μL [32] ]
1%1.02.02.5
2%2.04.05.1
5%5.010.012.6
10%10.020.025.3

Lugol's solution is commonly available in different potencies of (nominal) 1%, 2%, 5% or 10%. Iodine concentrations greater than 2.2% are subject to US regulations. [11] [33] [34] If the US regulations are taken literally, their 2.2% maximum iodine concentration limits a Lugol's solution to maximum (nominal) 0.87%.

The most commonly used (nominal) 5% solution consists of 5% (wt/v) iodine (I
2) and 10% (wt/v) potassium iodide (KI) mixed in distilled water and has a total iodine content of 126.4 mg/mL. The (nominal) 5% solution thus has a total iodine content of 6.32 mg per drop of 0.05 mL; the (nominal) 2% solution has 2.53 mg total iodine content per drop.

Potassium iodide renders the elementary iodine soluble in water through the formation of the triiodide (I−
3) ion. It is not to be confused with tincture of iodine solutions, which consist of elemental iodine, and iodide salts dissolved in water and alcohol. Lugol's solution contains no alcohol.

Other names for Lugol's solution are I
2KI (iodine-potassium iodide); Markodine, Strong solution (Systemic); and Aqueous Iodine Solution BP.

Economics

In the United Kingdom, in 2015, the NHS paid £9.57 per 500 ml of solution. [4]

Related Research Articles

<span class="mw-page-title-main">Hyperthyroidism</span> Clinical syndrome caused by excessive thyroid hormone

Hyperthyroidism is the condition that occurs due to excessive production of thyroid hormones by the thyroid gland. Thyrotoxicosis is the condition that occurs due to excessive thyroid hormone of any cause and therefore includes hyperthyroidism. Some, however, use the terms interchangeably. Signs and symptoms vary between people and may include irritability, muscle weakness, sleeping problems, a fast heartbeat, heat intolerance, diarrhea, enlargement of the thyroid, hand tremor, and weight loss. Symptoms are typically less severe in the elderly and during pregnancy. An uncommon but life-threatening complication is thyroid storm in which an event such as an infection results in worsening symptoms such as confusion and a high temperature; this often results in death. The opposite is hypothyroidism, when the thyroid gland does not make enough thyroid hormone.

<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">Staining</span> Technique used to enhance visual contrast of specimens observed under a microscope

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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.

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<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.

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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.

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References

  1. 1 2 3 "Strong Iodine Solution". The American Society of Health-System Pharmacists. Archived from the original on 13 January 2017. Retrieved 8 January 2017.
  2. ↑ Kaiho T (2014). Iodine Chemistry and Applications. John Wiley & Sons. p. 55. ISBN   9781118466292. Archived from the original on 18 September 2017.
  3. 1 2 Block SS (2001). Disinfection, Sterilization, and Preservation. Lippincott Williams & Wilkins. p. 177. ISBN   9780683307405. Archived from the original on 13 January 2017.
  4. 1 2 3 4 5 6 British National Formulary: BNF 69 (69th ed.). British Medical Association. 2015. p. 493. ISBN   9780857111562.
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  6. ↑ Fokom-Domgue J, Combescure C, Fokom-Defo V, Tebeu PM, Vassilakos P, Kengne AP, et al. (July 2015). "Performance of alternative strategies for primary cervical cancer screening in sub-Saharan Africa: systematic review and meta-analysis of diagnostic test accuracy studies". BMJ. 351: h3084. doi:10.1136/bmj.h3084. PMC   4490835 . PMID   26142020.
  7. 1 2 Preedy VR, Burrow GN, Watson RR (2009). Comprehensive Handbook of Iodine: Nutritional, Biochemical, Pathological and Therapeutic Aspects. Academic Press. p. 135. ISBN   9780080920863. Archived from the original on 12 August 2017.
  8. 1 2 Sneader W (2005). Drug Discovery: A History. John Wiley & Sons. p. 67. ISBN   9780471899792. Archived from the original on 26 August 2017.
  9. ↑ 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.
  10. ↑ World Health Organization (2021). World Health Organization model list of essential medicines: 22nd list (2021). Geneva: World Health Organization. hdl: 10665/345533 . WHO/MHP/HPS/EML/2021.02.
  11. 1 2 3 "Final Rule: Changes in the Regulation of Iodine Crystals and Chemical Mixtures Containing Over 2.2 Percent Iodine". US DEA. Federal Register. 2 July 2007. FR Doc E7-12736. Archived from the original on 13 September 2007.
  12. ↑ Erbil Y, Ozluk Y, Giriş M, Salmaslioglu A, Issever H, Barbaros U, et al. (June 2007). "Effect of lugol solution on thyroid gland blood flow and microvessel density in the patients with Graves' disease". The Journal of Clinical Endocrinology and Metabolism. 92 (6): 2182–2189. doi: 10.1210/jc.2007-0229 . PMID   17389702.
  13. ↑ Kaur S, Parr JH, Ramsay ID, Hennebry TM, Jarvis KJ, Lester E (May 1988). "Effect of preoperative iodine in patients with Graves' disease controlled with antithyroid drugs and thyroxine". Annals of the Royal College of Surgeons of England. 70 (3): 123–127. PMC   2498739 . PMID   2457351.
  14. ↑ Yokoyama A, Hirota T, Omori T, Yokoyama T, Kawakubo H, Matsui T, et al. (June 2012). "Development of squamous neoplasia in esophageal iodine-unstained lesions and the alcohol and aldehyde dehydrogenase genotypes of Japanese alcoholic men". International Journal of Cancer. 130 (12): 2949–60. doi:10.1002/ijc.26296. PMID   21796615.
  15. ↑ Inoue H, Kaga M, Ikeda H, Sato C, Sato H, Minami H, et al. (2015). "Magnification endoscopy in esophageal squamous cell carcinoma: a review of the intrapapillary capillary loop classification". Annals of Gastroenterology. 28 (1): 41–48. PMC   4290003 . PMID   25608626.
  16. ↑ Han JS, John V, Blanchard SB, Kowolik MJ, Eckert GJ (August 2008). "Changes in gingival dimensions following connective tissue grafts for root coverage: comparison of two procedures". Journal of Periodontology. 79 (8): 1346–1354. doi:10.1902/jop.2008.070472. PMID   18672983.
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  18. ↑ Van den Mooter M, Maraite H, Meiresonne L, Swings J, Gillis M, Kersters K, et al. (1 January 1987). "Comparison Between Xanthomonas campestris pv. manihotis (ISPP List 1980) and X. campestris pv. cassavae (ISPP List 1980) by Means of Phenotypic, Protein Electrophoretic, DNA Hybridization and Phytopathological Techniques". Microbiology . 133 (1). Microbiology Society: 57–71. doi: 10.1099/00221287-133-1-57 . ISSN   1350-0872.
  19. ↑ Lin TJ, Tanaka Y, Aznar R, Lin SC, Yamasaki Y, Hori S, et al. (May 1973). "Contraceptive effect of intrauterine application of Lugol's solution". American Journal of Obstetrics and Gynecology. 116 (2): 167–174. doi:10.1016/0002-9378(73)91044-2. PMID   4634105.
  20. ↑ Sreedharan A, Rembacken BJ, Rotimi O (June 2005). "Acute toxic gastric mucosal damage induced by Lugol's iodine spray during chromoendoscopy". Gut. 54 (6): 886–887. doi:10.1136/gut.2004.061739. PMC   1774547 . PMID   15888800.
  21. ↑ "Material Safety Data Sheet Iodine Solution, 5% MSDS". Archived from the original on 6 December 2016. Retrieved 29 September 2016.
  22. ↑ International Programme on Chemical Safety (2009), The WHO Recommended Classification of Pesticides by Hazard (PDF), World Health Organization, p. 5, archived from the original (PDF) on 10 May 2017, retrieved 28 September 2016
  23. ↑ A Guide to The Globally Harmonized System of Classification and Labeling of Chemicals (GHS) (PDF), US Occupational Safety and Health Administration (OSHA), p. 42, archived (PDF) from the original on 3 December 2016, retrieved 28 September 2016
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  25. ↑ Rotkiewicz M, Suchar H, Kamiñski R (14 January 2001). "Chernobyl: the Biggest BLUFF of the 20th Century". Polish weekly Wprost. pp. no 2. Archived from the original on 2 March 2005. Retrieved 18 June 2008.
  26. ↑ "Potassium Iodide as a Thyroid Blocking Agent in Radiation Emergencies" (PDF). Center for Drug Evaluation and Research (CDER). U.S. Department of Health and Human Services Food and Drug Administration. December 2001. Archived from the original (PDF) on 10 September 2011. Retrieved 12 January 2010.
  27. ↑ "Iodine". MedlinePlus. U.S. National Library of Medicine. Archived from the original on 4 August 2010.
  28. ↑ "Lugol's Solution". Drugs.com. Archived from the original on 25 November 2005.
  29. ↑ "Iodine". Optimox.com. Archived from the original on 6 May 2006.
  30. ↑ "Iodine". Jcrows.com. Archived from the original on 13 January 2007.
  31. ↑ Hawkins PR, Holliday J, Kathuria A, Bowling L (2005). "Change in cyanobacterial biovolume due to preservation by Lugol's Iodine". Harmful Algae. 4 (6): 1033–1043. doi:10.1016/j.hal.2005.03.001.
  32. 1 2 3 1 drop = 0.05 mL
  33. ↑ "Dear Registrant Handling the List 1 Chemical Iodine" (PDF). U.S. Department of Justice, Drug Enforcement Administration. 29 April 2008. Archived from the original (PDF) on 6 March 2016.
  34. ↑ Hardy J. "Has Gram Staining Without a License Become a Criminal Act?" (PDF). hardydiagnostics.com. Archived from the original (PDF) on 3 August 2016.
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