 Povidone-iodine applied to anabrasion using acotton swab. | |
| Clinical data | |
|---|---|
| Trade names | Betadine, Wokadine, Pyodine, others |
| Other names | polyvidone iodine, iodopovidone |
| AHFS/Drugs.com | Consumer Drug Information |
| License data | |
| Routes of administration | Topical |
| ATC code | |
| Legal status | |
| Legal status | |
| Identifiers | |
| |
| CAS Number | |
| PubChemCID | |
| DrugBank |
|
| ChemSpider |
|
| UNII | |
| KEGG | |
| ChEBI | |
| ChEMBL | |
| CompTox Dashboard(EPA) | |
| ECHA InfoCard | 100.110.412 |
| Chemical and physical data | |
| Formula | (C6H9NO)n·xI |
| Molar mass | variable |
 N Y (what is this?) (verify) | |
Povidone-iodine (PVP-I), also known asiodopovidone, is anantiseptic used forskin disinfection before and aftersurgery.[1][2] It may be used both to disinfect the hands of healthcare providers and the skin of the person they are caring for.[2] It may also be used for minorwounds.[2] It may be applied to the skin as a liquid, an ointment or a powder.[2][3]
Side effects include skin irritation and sometimes swelling.[1] If used on large wounds,kidney problems,high blood sodium, andmetabolic acidosis may occur.[1] It is not recommended in women who are less than 32 weekspregnant.[2] Frequent use is not recommended in people withthyroid problems or who are takinglithium.[2]
Povidone-iodine is achemical complex ofpovidone,hydrogen iodide, and elementaliodine.[4] The recommended strength solution contains 10% Povidone, with total iodine species equaling 10,000 ppm or 1% total titratable iodine.[4] It works by releasing iodine which results in the death of a range ofmicroorganisms.[1]
Povidone-iodine came into commercial use in 1955.[5] It is on theWorld Health Organization's List of Essential Medicines.[6] Povidone-iodine is availableover the counter.[7] It is sold under a number of brand names includingBetadine.[2]
Povidone-iodine is a broad spectrum antiseptic for topical application in the treatment and prevention ofwound infection. It may be used in first aid for minorcuts,burns,abrasions andblisters. Povidone-iodine exhibits longer lasting antiseptic effects thantincture 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,[8][9] and the combination ofsodium hypochlorite andhypochlorous acid in very low concentration is significantly superior forwound healing.[10]
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 inwounds,ulcers,cuts andburns; for the treatment of infections indecubitus ulcers andstasis ulcers; ingynecology forvaginitis associated withcandidal,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.[11][12]
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 withBurkholderia 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,[13] should be regarded with great caution: some bacteria are intrinsically resistant to a range of biocides including povidone-iodine.[14]
Abuffered PVP-Isolution of 2.5% concentration can be used for prevention ofneonatal conjunctivitis, especially if it is caused byNeisseria gonorrhoeae, orChlamydia trachomatis. It is currently unclear whether PVP-I is more effective in reducing the number of cases of conjunctivitis in neonates over other methods.[15] PVP-I appears to be very suitable for this purpose because, unlike other substances, it is also efficient againstfungi andviruses (includingHIV andHerpes simplex).[16]
It is used inpleurodesis (fusion of thepleura because of incessant pleural effusions). For this purpose, povidone-iodine is equally effective and safe astalc, and may be preferred because of easy availability and low cost.[17]
PVP-I is approved for treatment ofbacterial vaginosis as avaginalgel.[18][19][20] Brand names include Astodrimer Sodium or Astrodimer 1% Vaginal Gel, Betadine BV, Betafem BV, Viraleze, and VivaGel, among others.[18][19][20] Vaginalsuppositories are also available and used.[21]
There is strong evidence thatchlorhexidine anddenatured alcohol used to clean skin prior to surgery is better than any formulation of povidone-iodine.[8]
PVP-I is contraindicated in people withhyperthyroidism (overactivethyroid gland) and other diseases of the thyroid, after treatment withradioiodine, and in people withdermatitis herpetiformis[why?] (Duhring's disease).[22]
Thesensitization rate to the product is 0.7%.[23]
The iodine in PVP-I reacts withhydrogen peroxide,silver,taurolidine and proteins such as enzymes, rendering them (and itself) ineffective. It also reacts with manymercury compounds, giving the corrosive compoundmercury iodide, as well as with many metals, making it unsuitable for disinfecting metal piercings.[22]
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 exampleGuaiacum resin.[22]
Povidone-iodine is achemical complex of the polymerpovidone (polyvinylpyrrolidone, PVP) andtriiodide (I−
3).[24] It is synthesized by mixing the PVP polymer with iodine (I2), allowing the two to react.[25]
It is soluble in cold and mild-warm water,ethyl alcohol,isopropyl alcohol,polyethylene glycol, andglycerol. Its stability in solution is much greater than that of tincture of iodine orLugol's solution.
Free iodine, slowly liberated from the povidone-iodine (PVP-I) complex in solution, kills cells through iodination oflipids and oxidation ofcytoplasmic and membrane compounds. This agent exhibits a broad range of microbiocidal activity againstbacteria,fungi,protozoa, andviruses. Slow release of iodine from the PVP-I complex in solution minimizes iodine toxicity towards mammalian cells.
PVP-I can be loaded intohydrogels, which can be based oncarboxymethyl cellulose (CMC),poly(vinyl alcohol) (PVA), andgelatin, or on crosslinkedpolyacrylamide. These hydrogels can be used forwound 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.
Following the discovery ofiodine byBernard 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-spectrumbactericide, 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 acomplexed form and the concentration of free iodine is very low. The product thus serves as aniodophor.
PVP-I was discovered in 1955, at the Industrial Toxicology Laboratories in Philadelphia by H. A. Shelanski and M. V. Shelanski.[26] They carried out testsin vitro to demonstrate anti-bacterial activity, and found that the complex was less toxic in mice thantincture of iodine. Human clinical trials showed the product to be superior to other iodine formulations.[27]
Povidone-iodine has found application in the field of nanomaterials.[29] A wound-healing application has been developed which employs a mat of single wallcarbon nanotubes (SWNTs) coated in a monolayer of povidone-iodine.[28]
Research has previously found that the polymer polyvinylpyrrolidone (PVP, povidone) can coil around individual carbon nanotubes to make them water-soluble.[30]
Astodrimer Sodium, also referred to as Astodrimer 1% Vaginal gel, is a polyanionic dendrimer that prevents formation of bacterial biofilms through blocking bacterial adhesion (27). Randomized, placebo-controlled studies have demonstrated greater clinical cure rates for BV compared to placebo (46.2% vs. 11.5%) (101) and comparable to current antibiotic treatments (102). A recent randomized control trial (N = 864) demonstrated that Astodrimer, when applied every other day for 16 weeks following antibiotic therapy, was associated with a 20% reduction in recurrent BV compared to placebo during 16-week follow up (27). This product is not commercially available in the United States, but is sold over the counter in the United Kingdom (Betafem), Europe (Betadine BV) and also in Australia, New Zealand, Southeast Asia and South Africa.
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].
