Note: Lugol's 5% solution (potassium iodide 10% and iodine 5%) contains ~6.25 mg iodine/iodide per drop; 1 drop = 0.05 mL (ACR-SPR 2015; manufacturer's labeling). Errors have occurred involving iodine-containing solutions; verify the indication and intended solution concentration before administration (ISMP 2011).
Antiseptic: Topical: Apply directly to area(s) requiring antiseptic.
Graves disease, thyroidectomy preparation:
Note: Use is not recommended in patients with thyrotoxicosis caused by a toxic adenoma or toxic multinodular goiter due to the risk of exacerbating hyperthyroidism (ATA [Ross 2016]).
Oral: Lugol's 5% solution: 5 to 7 drops (0.25 to 0.35 mL) 3 times daily for 10 days before surgery (ATA [Ross 2016]).
Note: Antithyroid drug therapy (eg, methimazole) is started several weeks before surgery to achieve euthyroidism; if not euthyroid prior to surgery, or if urgent surgery is required, consider concurrent beta-blockade (eg, propranolol) in the immediate preoperative period to reduce the risk of thyroid storm (ATA [Ross 2016]; Burch 2015).
Thyroid gland protection during radiopharmaceutical use (off-label use): Note: Regimens/protocols vary by radiopharmaceutical. Generally, ~100 mg/day of iodine/iodide is required for thyroid block (ACR-ACNM [Subramaniam 2017]; Anderson 2012; Taïeb 2012). Initiate 1 to 48 hours prior to radiopharmaceutical exposure and continue after radiopharmaceutical administration until risk of exposure has diminished (treatment initiation time and duration are dependent on the radiopharmaceutical agent used, consult specific protocol or labeling). The following product-specific recommendations are provided in the radiopharmaceutical manufacturer's labeling:
Iodine I-123 radiopharmaceuticals: Oral: Lugol’s 5% solution: 16 drops/day (0.8 mL/day) to achieve a dose of 100 mg/day of iodine/iodide (radiopharmaceutical manufacturer's labeling [Adreview, Datscan]).
Iodine I-125 and I-131 radiopharmaceuticals: Oral: Lugol’s 5% solution: 10 drops (0.5 mL) 3 times daily (radiopharmaceutical manufacturer's labeling [Jeanatope, Megatope, Volumex]). The manufacturer's labeling for Azedra does not provide specific dosing recommendations.
Thyroid storm: Note: Administer at least 1 hour after antithyroid drug administration (eg, propylthiouracil, methimazole) (ATA [Ross 2016]).
Oral: Lugol's 5% solution: 4 to 10 drops (0.2 to 0.5 mL) every 6 to 8 hours (ATA [Ross 2016]; Nayak 2006; Ross 2022). May discontinue after evidence of clinical improvement (eg, defervescence, resolution of CNS and cardiovascular manifestations); for patients undergoing thyroidectomy within 10 to 14 days of initiating iodine therapy, may continue until day of surgery (ATA [Ross 2016]; Nayak 2006; Ross 2022).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
(For additional information see "Potassium iodide and iodine (Lugol solution): Pediatric drug information")
Dosage guidance:
Safety: Errors have occurred during the prescribing, dispensing, and administration of iodine-containing solutions; verify the dosing units (eg, drops, mL) and intended solution concentration before administration (ISMP 2011). Doses may be presented as drops or mL; use caution and carefully verify dosage units before dispensing or administering.
Dosage form information: Lugol's 5% solution (potassium iodide 10% and iodine 5%) contains ~6.25 mg iodine per drop; 1 drop = 0.05 mL (ACR-SPR 2015; Minamitani 2017; manufacturer's labeling).
Thyrotoxic crisis/thyroid storm: Limited data available: Children and Adolescents: Lugol's 5% solution: Oral: 4 to 10 drops (0.2 to 0.5 mL) 3 times daily; begin therapy preferably 1 hour following the initial dose of either propylthiouracil or methimazole (ETA [Mooij 2022]; Nichols 2008).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer’s labeling.
There are no dosage adjustments provided in the manufacturer’s labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
Frequency not defined.
Cardiovascular: Cardiac arrhythmia, myxedema
Central nervous system: Confusion, fatigue, metallic taste, numbness, tingling sensation
Dermatologic: Skin rash
Endocrine & metabolic: Goiter, hyperthyroidism, hypothyroidism
Gastrointestinal: Diarrhea, enlargement of salivary glands, gastric distress, gastrointestinal hemorrhage, nausea, salivary gland disease (tenderness), stomach pain, vomiting
Hematologic & oncologic: Adenopathy, thyroid adenoma
Hypersensitivity: Hypersensitivity reaction (angioedema, cutaneous and mucosal hemorrhage, serum sickness-like symptoms)
Neuromuscular & skeletal: Arthralgia, weakness
Respiratory: Pharyngeal edema
Miscellaneous: Drug overdose (with prolonged treatment/high doses), fever, iodism
Hypersensitivity to iodine or any component of the formulation; tuberculosis (TB) disease (active TB); dermatitis herpetiformis; hypocomplementemic vasculitis; nodular thyroid disease with heart disease
Concerns related to adverse effects:
• Hypothyroidism: Prolonged use can lead to hypothyroidism.
• Skin reactions: Can cause acne flare-ups and/or dermatitis.
Disease-related concerns:
• Adrenal insufficiency: Use with caution in patients with Addison disease.
• Bronchitis: Use with caution in patients with acute bronchitis.
• Cardiac disease: Use with caution in patients with cardiac disease.
• Myotonia congenita: Use with caution in patients with myotonia congenita.
• Renal impairment: Use with caution in patients with renal impairment.
• Thyroid disease: Use with caution in patients with a history of hyperthyroidism.
• Tuberculosis: Use with caution in patients with tuberculosis.
Lugol's 5% oral solution (potassium iodide 10% and iodine 5%) contains potassium iodide 100 mg/mL and iodine 50 mg/mL and provides 6.25 mg iodide/iodine per drop.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, External:
Lugols Strong Iodine: Potassium iodide 10% and iodine 5% (8 mL)
Generic: Potassium iodide 10% and iodine 5% (8 mL)
Solution, Oral:
Generic: Potassium iodide 10% and iodine 5% (14 mL, 473 mL)
Tincture, External:
Generic: Potassium iodide 5% and iodine 7% (30 mL, 480 mL)
Yes
Topical: Apply topically directly to area(s) requiring antiseptic.
Oral: Dilute with water or juice. In patients with thyroid storm, administer at least 1 hour after antithyroid drug administration (eg, propylthiouracil, methimazole).
Oral: Dilute with water or fruit juice.
Antiseptic: Topical antiseptic.
Graves disease, thyroidectomy preparation: Treatment of hyperthyroidism in the immediate preoperative period in patients undergoing thyroidectomy.
Note: Iodine therapy is not recommended in the preoperative setting in patients with thyrotoxicosis caused by a toxic adenoma or toxic multinodular goiter due to the risk of exacerbating hyperthyroidism (ATA [Ross 2016]).
Thyroid storm: Treatment of thyroid storm (as part of a multimodality treatment approach).
Note: The American Thyroid Association and American Association of Clinical Endocrinologists guidelines for the management of hyperthyroidism and other causes of thyrotoxicosis recommend potassium iodide and iodine (Lugol's solution) as an acceptable alternative to saturated solution of potassium iodide (SSKI) in the management of adults with thyrotoxic crisis/thyroid storm (ATA [Ross 2016]).
Thyroid gland protection during radiopharmaceutical use
Potassium iodide and iodine (Strong Iodide Solution or Lugol's solution) may be confused with potassium iodide products, including saturated solution of potassium iodide (SSKI)
Dosage volume: Dosing errors have been reported during the prescribing, dispensing, and administration of potassium iodide-containing solutions (eg, Lugol's, SSKI). Errors have occurred when mL doses were administered, when only drops were indicated for the dose. Carefully review dosage and administration information; appropriate oral dosage is most commonly expressed as drops to provide doses less than 1 mL. Dispensing unit doses is also highly recommended; pharmacists should never dispense quantities that could be lethal if consumed as a single dose (ISMP 2011).
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Aliskiren: Potassium Salts may enhance the hyperkalemic effect of Aliskiren. Risk C: Monitor therapy
AMILoride: Potassium Salts may enhance the hyperkalemic effect of AMILoride. Management: Amiloride and potassium supplements should not be used except in severe or refractory cases of hypokalemia. If coadministered, monitor serum potassium closely as rapid increases in potassium are possible. Risk D: Consider therapy modification
Angiotensin II Receptor Blockers: Potassium Salts may enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy
Angiotensin-Converting Enzyme Inhibitors: Potassium Salts may enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor therapy
Cardiac Glycosides: Antithyroid Agents may increase the serum concentration of Cardiac Glycosides. Risk C: Monitor therapy
Drospirenone-Containing Products: May enhance the hyperkalemic effect of Potassium Salts. Risk C: Monitor therapy
Eplerenone: May enhance the hyperkalemic effect of Potassium Salts. Management: This combination is contraindicated in patients receiving eplerenone for treatment of hypertension. Potassium supplements may be needed to treat/prevent hypokalemia in select patients with heart failure receiving eplerenone and high dose loop diuretics. Risk D: Consider therapy modification
Finerenone: Potassium Salts may enhance the hyperkalemic effect of Finerenone. Risk C: Monitor therapy
Heparins (Low Molecular Weight): May enhance the hyperkalemic effect of Potassium Salts. Risk C: Monitor therapy
Lithium: Potassium Iodide may enhance the hypothyroid effect of Lithium. Risk C: Monitor therapy
MetyraPONE: Antithyroid Agents may diminish the diagnostic effect of MetyraPONE. Management: Consider alternatives to the use of the metyrapone test in patients taking antithyroid agents. Risk D: Consider therapy modification
Nicorandil: May enhance the hyperkalemic effect of Potassium Salts. Risk C: Monitor therapy
Nonsteroidal Anti-Inflammatory Agents: May enhance the hyperkalemic effect of Potassium Salts. Risk C: Monitor therapy
Sodium Iodide I131: Potassium Iodide may diminish the therapeutic effect of Sodium Iodide I131. Management: Discontinue potassium iodide at least 3 weeks before sodium iodide I-131 administration, and avoid concurrent use. Risk X: Avoid combination
Sodium Iodide I131: Iodine may diminish the therapeutic effect of Sodium Iodide I131. Management: Discontinue topical iodine at least 3 weeks before sodium iodide I-131 administration, and avoid concurrent use. Risk X: Avoid combination
Spironolactone: Potassium Salts may enhance the hyperkalemic effect of Spironolactone. Risk X: Avoid combination
Theophylline Derivatives: Antithyroid Agents may increase the serum concentration of Theophylline Derivatives. Risk C: Monitor therapy
Triamterene: Potassium Salts may enhance the hyperkalemic effect of Triamterene. Risk X: Avoid combination
Vitamin K Antagonists (eg, warfarin): Antithyroid Agents may diminish the anticoagulant effect of Vitamin K Antagonists. Risk C: Monitor therapy
Potassium iodide/iodine may be used in the management of thyroid storm or thyrotoxic heart failure in pregnant patients (ACOG 2020). Potassium iodide solution may be preferred for use in pregnant patients with hyperthyroidism who do not tolerate antithyroid medications in preparation for surgery (ATA [Alexander 2017]).
Refer to the Sodium Iodide monograph for additional information related to systemic iodine and pregnancy.
Refer to the Iodine monograph for additional information related to topical iodine exposure and pregnancy.
Iodine is present in breast milk; concentrations vary depending on maternal dietary intake (IOM 2001).
Refer to the Sodium Iodide monograph for additional information related to systemic iodine and pregnancy.
Refer to the Iodine monograph for additional information related to topical iodine exposure and pregnancy.
Thyroid function tests, signs/symptoms of hyperthyroidism; following radioiodine exposure, monitor thyroid function in pregnant patients, neonates, and young infants if repeat doses are required.
In hyperthyroidism, iodine temporarily inhibits thyroid hormone synthesis and secretion into the circulation; use also decreases thyroid gland size and vascularity. Serum T4 and T3 concentrations can be reduced for several weeks with use but effect will not be maintained.
Following radioactive iodine exposure, potassium iodide blocks uptake of radioiodine by the thyroid, reducing the risk of thyroid cancer.
Onset of action: Hyperthyroidism: 24 to 48 hours
Peak effect: 10 to 15 days after continuous therapy
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