Usage
- Cadexomer iodine is prescribed for the topical treatment of chronic exuding wounds such as venous leg ulcers, diabetic foot ulcers, and pressure ulcers. It is also used for infected traumatic and surgical wounds, and as an antiseptic for minor burns, cuts, and scrapes.
- Pharmacological Classification: Topical antimicrobial agent.
- Mechanism of Action: Cadexomer iodine is composed of microbeads of a modified starch (cadexomer) containing iodine. These beads absorb wound exudate and gradually release iodine, which has broad-spectrum antimicrobial activity against bacteria, fungi, protozoa, and viruses. The iodine also promotes debridement (removal of dead tissue) and helps to maintain a moist wound environment.
Alternate Names
How It Works
- Pharmacodynamics: Cadexomer iodine’s primary effect is antimicrobial, resulting in reduced bacterial burden within the wound. It also absorbs wound exudate, promoting a cleaner wound bed and aiding in autolytic debridement. The moist environment created by the cadexomer beads supports wound healing.
- Pharmacokinetics: Iodine is slowly released from the cadexomer beads upon contact with wound exudate. The amount of iodine released depends on the volume of exudate. Systemic absorption of iodine is minimal, particularly in ischemic wounds where blood flow is reduced.
- Mode of Action: Iodine exerts its antimicrobial effect by penetrating microbial cell walls and disrupting protein synthesis and cell membrane function, leading to cell death.
- Elimination Pathways: Absorbed iodine is primarily excreted by the kidneys.
Dosage
Standard Dosage
Adults:
- Apply a thin layer of cadexomer iodine ointment or powder to the wound bed, ensuring a depth of approximately 3mm. For Iodosorb gel, spread 1/8-1/4 inch onto dry sterile gauze and apply to the wound.
- Dressings should be changed 2-3 times per week, or daily if the wound has heavy exudate, or when the dressing changes color from brown to yellow/gray, indicating iodine depletion.
- Maximum single application: 50g. Maximum weekly dose: 150g. Do not use continuously for more than 3 months.
Children:
- Safety and efficacy have not been established in children under 12 years of age. Use is not recommended in children aged 0-18 years, unless under direct medical supervision.
Special Cases:
- Elderly Patients: No specific dosage adjustments are required based on age.
- Patients with Renal Impairment: Use with caution in patients with renal impairment, especially if large wounds are being treated, due to potential iodine absorption. Use is not recommended in patients with severe renal impairment.
- Patients with Hepatic Dysfunction: No specific dosage adjustments are needed for hepatic impairment, as iodine is primarily excreted renally.
- Patients with Comorbid Conditions: Use with caution in patients with thyroid disorders (Hashimoto’s thyroiditis, Graves’ disease, non-toxic goiter). Iodine absorption can exacerbate these conditions.
Clinical Use Cases
Dosing in these settings follows the standard adult recommendations, with adjustments as needed based on wound size and exudate level:
- Intubation: Not applicable for Cadexomer Iodine.
- Surgical Procedures: Can be used for post-surgical wound infections, following standard dosage recommendations.
- Mechanical Ventilation: Not applicable for Cadexomer Iodine.
- Intensive Care Unit (ICU) Use: Can be used in the ICU setting for wound management, following standard dosage recommendations.
- Emergency Situations: Not applicable for Cadexomer Iodine.
Dosage Adjustments
- Reduce dosage for larger wounds to maintain maximum application and weekly limits.
- Monitor patients with renal impairment for signs of iodine toxicity if large wounds are being treated.
Side Effects
Common Side Effects
- Mild, transient pain or burning sensation at the application site.
- Redness or swelling at the application site.
- Itching or irritation.
Rare but Serious Side Effects
- Allergic reactions (rash, hives, difficulty breathing, swelling of the face, lips, tongue, or throat).
Long-Term Effects
- Skin dryness with prolonged use.
Adverse Drug Reactions (ADR)
- Eczema
- Hypersensitivity reaction
- Increased thyroid-stimulating hormone (TSH) level
Contraindications
- Hypersensitivity to iodine or any component of the formulation.
- Hashimoto’s thyroiditis, history of Graves’ disease, or non-toxic goiter.
- Pregnancy and breastfeeding.
- Dry wounds.
Drug Interactions
- Lithium: May increase the risk of hypothyroidism.
- Mercurial antiseptics (e.g., mercurochrome, thiomersal): Avoid concomitant use.
- Taurolidine: Avoid concomitant use.
Pregnancy and Breastfeeding
- Pregnancy Safety Category: Not established, contraindicated due to potential fetal thyroid effects.
- Breastfeeding: Iodine is excreted in breast milk; contraindicated due to potential effects on infant thyroid function.
Drug Profile Summary
- Mechanism of Action: Releases iodine, providing broad-spectrum antimicrobial activity, absorbs wound fluid, and promotes debridement.
- Side Effects: Local irritation, pain, redness, swelling. Rarely, allergic reactions.
- Contraindications: Iodine sensitivity, thyroid disorders, pregnancy, breastfeeding, dry wounds.
- Drug Interactions: Lithium, mercurial antiseptics, taurolidine.
- Pregnancy & Breastfeeding: Contraindicated.
- Dosage: Apply thin layer to wound 2-3 times per week. Max 50g/application, 150g/week.
- Monitoring Parameters: Wound size, exudate level, signs of local irritation or allergic reaction, thyroid function in patients at risk.
Popular Combinations
- No specific drug combinations are routinely recommended.
Precautions
- General Precautions: Limit use to one patient per tube. Do not use for more than 3 months continuously. Avoid contact with eyes, ears, and mucous membranes. Monitor for signs of local irritation or allergic reaction.
- Specific Populations: See Dosage/Special Cases section.
- Lifestyle Considerations: No specific restrictions.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Cadexomer Iodine?
A: Apply a thin layer to the wound 2-3 times per week. Maximum 50g per application and 150g per week. Do not use for more than 3 months continuously.
Q2: How does Cadexomer Iodine work?
A: It releases iodine, providing broad-spectrum antimicrobial activity. It also absorbs exudate and promotes debridement.
Q3: What are the common side effects?
A: Local irritation, pain, redness, and swelling.
Q4: Is Cadexomer Iodine safe for use during pregnancy or breastfeeding?
A: No, it is contraindicated in both pregnancy and breastfeeding due to potential iodine transfer to the fetus or infant.
Q5: Can Cadexomer Iodine be used on dry wounds?
A: No, it is intended for use on exuding wounds, as the iodine release mechanism is dependent on moisture.
Q6: Are there any drug interactions I should be aware of?
A: Yes, avoid concomitant use with lithium, mercurial antiseptics, and taurolidine.
Q7: Can Cadexomer Iodine be used in patients with thyroid disorders?
A: No, it is contraindicated in patients with Hashimoto’s thyroiditis, Graves’ disease, or non-toxic goiter.
Q8: What should I do if a patient experiences an allergic reaction?
A: Discontinue use immediately and provide appropriate medical care.
Q9: How long can Cadexomer Iodine be used continuously?
A: Treatment should not exceed 3 months of continuous use.
Q10: What is the difference between cadexomer iodine ointment and powder?
A: Both provide iodine and absorb exudate, but the choice between ointment and powder depends on the specific wound characteristics and clinician preference. Ointment may be better for deeper wounds, while powder is suitable for more superficial wounds.
