Version May 2024
Note: Doses may be presented as drops, mL, or mg depending on indication and/or product. SSKI solution contains potassium iodide 1 g per mL; 1 drop = 0.05 mL = 50 mg (ATA [Ross 2016]). Errors have occurred involving iodine-containing solutions; verify the indication and intended solution concentration before administration (ISMP 2011).
Expectorant: Oral: SSKI solution: 300 to 600 mg (0.3 to 0.6 mL) 3 to 4 times daily.
Graves disease, thyroidectomy preparation (off-label use):
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: SSKI solution: 1 to 2 drops (50 to 100 mg or 0.05 to 0.1 mL) 3 times daily for 7 to 10 days before surgery; alternatively, may administer as a single daily dose (ATA [Ross 2016]; Whalen 2017).
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).
Sporotrichosis, cutaneous or lymphocutaneous (alternative agent) (off-label use): Oral: SSKI solution: Initial: 5 drops (250 mg or 0.25 mL) 3 times daily. Increase dose by 3 to 5 drops/day (150 to 250 mg/day or 0.15 to 0.25 mL/day) based on response as tolerated up to 50 drops (2.5 g or 2.5 mL) 3 times daily; continue therapy until 2 to 4 weeks after lesions have resolved (usual duration: 3 to 6 months) (Kauffman 2007; Rezende 2021).
Thyroid block following nuclear radiation emergency: Includes pregnant or lactating patients: Oral: iOSAT or ThyroSafe: 130 mg once daily; continue for 10 to 14 days or as directed by public officials (until risk of exposure has passed or other measures are implemented).
Note: For internal exposure to radioactive iodine, patients should receive potassium iodide following known or predicted thyroid exposures as follows (AAP 2003; AAP [Linet 2018]; REMM 2022a; REMM 2022b):
>40 years of age: ≥5 Gy.
18 to 40 years of age: ≥0.1 Gy.
Pregnant or lactating patients: ≥0.05 Gy.
Thyroid gland protection during radiopharmaceutical use (off-label use): Oral: Tablets or SSKI solution: 130 to 300 mg (~3 to 6 drops or ~0.15 to 0.3 mL SSKI solution) per day (ACR-ACNM [Subramaniam 2017]; ACR-SPR 2015; Bombardier 2010; Taïeb 2012).
Note: Begin at 1 to 48 hours prior to exposure. Continue potassium iodide after radiopharmaceutical administration until risk of exposure has diminished (treatment duration and time of initiation is dependent on the radiopharmaceutical, consult specific protocol).
Thyroid storm (off-label use):
Note: Administer at least 1 hour after antithyroid drug administration (eg, propylthiouracil, methimazole) (ATA [Ross 2016]).
Oral: SSKI solution: 5 drops (250 mg or 0.25 mL) every 6 hours (ATA [Ross 2016]). 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; use with caution.
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
(For additional information see "Potassium iodide (SSKI, Thyroshield): Pediatric drug information")
Note: Doses may be presented as drops, mL, or mg depending on indication and/or product. SSKI contains 1 g/mL; 1 drop = 0.05 mL = 50 mg (ATA [Ross 2016]). Use caution to ensure the proper dose is ordered and administered.
Sporotrichosis, cutaneous: Note: Alternative agent: Limited data available: Children and Adolescents: SSKI 1 g/mL: Oral: Initial: 1 drop (50 mg or 0.05 mL) 3 times daily; increase dose as tolerated; maximum dose: 1 drop/kg/dose or 50 drops/dose, whichever is lowest; continue at the maximum tolerated dosage for several weeks after lesions have resolved (IDSA [Kauffman 2007]; Red Book [AAP 2018]).
Thyroid block following nuclear radiation emergency: Iosat, ThyroSafe:
Note: Continue treatment for 10 to 14 days or as directed by public officials (until the risk of exposure has passed or other measures are implemented) (FDA 2001). For internal exposure to radioactive iodine, pediatric patients should receive potassium iodide following known or predicted thyroid exposures ≥0.05 Gy (AAP 2003; AAP [Linet 2018]; REMM 2022c).
Infants and Children ≤3 years: Oral: 32.5 mg once daily.
Children >3 to 12 years: Oral: 65 mg once daily.
Adolescents:
Weight <68 kg: Oral: 65 mg once daily.
Weight ≥68 kg: Oral: 130 mg once daily.
Thyroid gland protection during radiopharmaceutical use: Limited data available; Note: Begin at 1 to 48 hours prior to exposure; continue potassium iodide after radiopharmaceutical administration until risk of exposure has diminished (treatment duration and time of initiation is dependent on the radiopharmaceutical; consult specific protocol):
Age-directed dosing (Olivier 2003):
Infants and Children <3 years: Oral: 32 mg once daily.
Children and Adolescents 3 to 13 years: Oral: 65 mg once daily.
Adolescents >13 years: Oral: 130 mg once daily.
Weight-directed dosing (Giammarile 2008):
<5 kg: Oral: 16 mg once daily.
5 to <15 kg: Oral: 32 mg once daily.
15 to <50 kg: Oral: 65 mg once daily.
≥50 kg: Oral: 130 mg once daily.
Thyroidectomy in Graves disease, preoperative preparation: Limited data available:
Patients receiving methimazole: Children and Adolescents: SSKI 1 g/mL: Oral: 1 to 2 drops (50 to 100 mg or 0.05 to 0.1 mL) 3 times daily; administer for 10 days prior to surgery (ATA [Ross 2016]).
Patients unable to take or intolerant to methimazole or need for urgent thyroidectomy: Children and Adolescents: SSKI 1 g/mL: Oral: 3 to 7 drops (150 to 350 mg or 0.15 to 0.35 mL) 3 times daily; administer for 10 days before surgery in combination with beta-blockade (ATA [Ross 2016]).
Thyrotoxic crisis/thyroid storm: (Eyal 2008): Note: Administer at least 1 hour after antithyroid drug (eg, methimazole) administration:
Infants: SSKI 1 g/mL: Oral: 2 drops (100 mg or 0.1 mL) 4 times daily.
Children and Adolescents: SSKI 1 g/mL: Oral: 5 drops (250 mg or 0.25 mL) 2 to 4 times daily.
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 are derived from product labeling unless otherwise specified. Frequency not defined.
Cardiovascular: Cardiac arrhythmias
Dermatologic: Skin rash
Gastrointestinal: Diarrhea, gastric distress, gastrointestinal hemorrhage, nausea, sialadenitis (including tenderness), stomach pain, vomiting
Nervous system: Asthenia (hands and feet), confusion, fatigue, numbness, tingling sensation
Neuromuscular & skeletal: Lower extremity pain (feet), upper extremity pain (hands)
Respiratory: Pharyngeal edema
Miscellaneous: Fever, neck edema
Hypersensitivity to iodide, iodine, or any component of the formulation; dermatitis herpetiformis; hypocomplementemic vasculitis, nodular thyroid condition with heart disease
Concerns related to adverse effects:
• Hypersensitivity: Iodide hypersensitivity may occur, manifesting as angioedema, cutaneous/mucosal hemorrhage, and serum sickness-like symptoms (fever, arthralgia, lymph node enlargement, and eosinophilia).
• Skin reactions: Can cause acne flare-ups and/or dermatitis.
• Thyroid adverse effects: Prolonged use may lead to hypothyroidism. Iodide may cause underactive or overactive thyroid; thyroid enlargement may also occur. Use with caution in patients with a history of hyperthyroidism. Iodism or chronic iodide poisoning may occur with high doses or prolonged treatment; symptoms include burning of mouth/throat, sore teeth/gums, severe headache, metallic taste, eye irritation/eye lid swelling, increased salivation, acneform skin lesions, and (rarely) severe skin lesions; withhold potassium iodide treatment and manage with supportive care.
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
• Tuberculosis: Use with caution in patients with tuberculosis.
Special populations:
• Pediatric: In a nuclear radiation emergency, infants and children are more likely to experience thyroid damage. Neonates <1 month are at higher risk for hypothyroidism with potassium iodide use; evaluate thyroid function if repeat dosing is required in this patient population.
Other warnings/precautions:
• Appropriate use: For thyroid gland protection (radiopharmaceutical use), potassium iodide must be administered prior to receiving radiopharmaceuticals that require thyroid gland protection. For nuclear radiation emergency, take only when instructed by public health officials; do not take more or more often than instructed; follow other emergency measures recommended by officials.
Use with caution in patients with cystic fibrosis; may have exaggerated susceptibility to goitrogenic effects (Dolan 1971).
Some dosage forms may contain propylene glycol; in neonates, large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP 1997; Shehab 2009).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution, Oral:
SSKI: 1 g/mL (30 mL, 237 mL)
Generic: 65 mg/mL (30 mL)
Tablet, Oral:
iOSAT: 130 mg [scored]
ThyroSafe: 65 mg [scored]
May be product dependent
Solution (Potassium Iodide (Antidote) Oral)
65 mg/mL (per mL): $0.75
Solution (SSKI Oral)
1 g/mL (per mL): $17.33
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Oral:
SSKI solution: Dilute in a glassful of water, fruit juice, or milk. Administer with food or milk to decrease gastric irritation. In patients with thyroid storm, administer at least 1 hour after antithyroid drug administration (eg, propylthiouracil, methimazole).
iOSAT, ThyroSafe: Administer as soon as possible after instructed to do so by public officials. Do not take more than 1 dose in 24 hours. Tablets may be administered whole or crushed and then mixed with water, low fat milk (white or chocolate), orange juice, soda (flat), raspberry syrup, or infant formula. Raspberry syrup disguises the taste best; low-fat white milk or water do not hide the salty taste well) (AAP 2003). See Extemporaneously Prepared.
Oral:
SSKI: Dilute with a large quantity of water, fruit juice, milk, or broth; take with food or milk to decrease gastric irritation.
Iosat, ThyroSafe: Take as soon as possible after instructed to do so by public officials. Take every 24 hours; do not take more than 1 dose in 24 hours. Tablets may be crushed and mixed with water, low fat milk (white or chocolate), orange juice, soda (flat), raspberry syrup, or infant formula. Raspberry syrup disguises the taste best; low-fat white milk or water do not hide the salty taste well (AAP 2003).
Thyroid block following nuclear radiation emergency: Block thyroidal uptake of radioactive isotopes of iodine in a nuclear radiation emergency.
Expectorant: Expectorant for the symptomatic treatment of chronic pulmonary diseases complicated by mucous.
Graves disease, thyroidectomy preparation; Sporotrichosis, cutaneous or lymphocutaneous (alternative); Thyroid gland protection during radiopharmaceutical use; Thyroid storm
Potassium iodide products, including saturated solution of potassium iodide (SSKI) may be confused with potassium iodide and iodine (Strong Iodide Solution or Lugol's solution)
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
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 is approved for use during a nuclear radiation emergency to block thyroidal uptake of radioactive isotopes of iodine. During an emergency, pregnant patients are at a high risk of developing thyroid dysfunction and thyroid cancer following exposure and should be prioritized for potassium iodide treatment. Treatment should begin immediately before or during the passage of the radioactive cloud, but delayed administration is still beneficial. Repeated doses may suppress fetal thyroid function and are therefore not recommended. Instead, pregnant patients should be prioritized for evacuation from the exposure area (AAP [Linet 2018]; ATA [Leung 2017]).
If inadvertent exposure to the therapeutic use of sodium iodide I131 during pregnancy occurs, maternal potassium iodide may be administered to protect the fetal thyroid. Treatment must be given within 12 hours of exposure but may not be needed if the mother is <12 weeks gestation (ATA [Alexander 2017]).
Potassium iodide may also be used off label in patients with Graves disease undergoing thyroidectomy. Potassium iodide is recommended for use in pregnant patients with hyperthyroidism who do not tolerate antithyroid medications in preparation for surgery (ATA [Alexander 2017]). Potassium iodide may also be used in the management of thyroid storm or thyrotoxic heart failure in pregnant patients (ACOG 2020).
Use of potassium iodide as an expectorant is not recommended in pregnant patients. Neonatal hypothyroidism and goiter (in some cases causing tracheal obstruction leading to neonatal death) have been reported following chronic maternal use as an expectorant (AAP 1976; Bostanci 2001).
Also refer to Sodium Iodide monograph for additional information.
Potassium iodide is present in breast milk.
Exposure to potassium iodide via breast milk may cause skin rash and thyroid suppression in the breastfed infant.
Potassium iodide is approved for use during a nuclear radiation emergency to block thyroidal uptake of radioactive isotopes of iodine. In this scenario, exposure to iodide I131 via breast milk is expected to be higher than potassium iodide treatment ingested by the mother. During an emergency, breastfeeding patients are at a high risk of developing thyroid dysfunction and thyroid cancer following exposure and should be prioritized for potassium iodide treatment. Treatment should begin immediately before or during the passage of the radioactive cloud, but delayed administration is still beneficial. Repeated doses of potassium iodide are not recommended. Instead, breastfeeding patients should be prioritized for evacuation from the exposure area. Breast milk can be expressed and discarded until it is deemed safe to resume feeding (AAP [Linet 2018]; ATA [Leung 2017]).
Breastfeeding is not recommended when potassium iodide is used as an expectorant (AAP 1976).
Also refer to Sodium Iodide monograph for additional information.
Thyroid function tests (thyroid function should be monitored in patients who are pregnant or lactating, neonates, and young infants if repeat doses are required following radioactive iodine exposure); signs/symptoms of hypo- or hyperthyroidism.
Reduces viscosity of mucus by increasing respiratory tract secretions; inhibits secretion of thyroid hormone, fosters colloid accumulation in thyroid follicles. Following radioactive iodine exposure, potassium iodide blocks the uptake of radioactive iodine by the thyroid, reducing the risk of thyroid cancer.
Onset of action: Hyperthyroidism: 24 to 48 hours (Nayak 2006)
Peak effect: Hyperthyroidism: ~2 weeks after continuous therapy (Nayak 2006)
Duration: Radioactive iodine exposure: Each dose has a duration of ~24 hours
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