Sodium hypochlorite (household bleach, 5.25%) can be diluted and used as a topical, irrigant antiseptic for cleansing and disinfecting of wounds. It is applied topically, usually by irrigation, soaks, or wet compresses. Dakin's solution is a 0.5% (full strength), 0.25% (half strength), or 0.125% (quarter strength) dilution of sodium hypochlorite in water, usually with the addition of boric acid or sodium bicarbonate as buffers to neutralize the pH. Original formulations of Dakin's solution were first described by Dr. Henry D. Dakin during World War I, in collaboration with a surgeon, Dr. Alexis Carrel. Sodium hypochlorite solutions were primarily compounded by pharmacists prior to commercial availability. The irrigant solutions are considered non-prescription (OTC) products in the US.
General Administration Information
For storage information, see the specific product information within the How Supplied section.
Route-Specific Administration
Topical Administration
Dakin's solution:
-For external use only.
-Undiluted solution should not be applied directly to the skin.
-Properly diluted and prepared Dakin's solution (full-, half-, or quarter-strength): pour on or apply to affected area to irrigate and clean. May also be used as the wetting agent for a wet-to-moist dressing.
-Protect any intact skin adjacent to the treated area(s) with a moisture barrier or skin sealant.
-NOTE: This product may bleach clothing, furniture fabrics, or other objects.
-Keep tightly closed when not in use. Store at room temperature.
Sodium hypochlorite 0.057% cleanser solution:
-For external use only.
-Debride wound, if necessary.
-Spray solution onto entire wound bed, including wound margin. Avoid pooling.
-Alternatively, saturate sterile gauze pad with solution and apply to wound site.
-Cover wound with sterile gauze or other appropriate dressing.
-Ensure wound remains moist between dressing changes.
Sodium hypochlorite 0.057% gel:
-For external use only.
-For wound management:
--Debride the wound or cleanse the affected area with appropriate skin cleanser; allow the area to dry.
-Apply the gel topically to entire wound bed, including areas of undermining.
-Apply a thin coating to peri-wound skin area and allow to dry.
-Cover with appropriate dressing.
-Ensure wound remains moist between dressing changes.
-For indwelling vascular catheters:
--Apply the gel topically to completely cover skin area around the indwelling vascular catheter.
-Cover with appropriate dressing.
-For ostomy care:
--Apply thin coating topically to peristomal area.
-Allow to dry.
-Apply ostomy appliance.
Never use sodium hypochlorite (bleach) directly on the skin. Before use, ensure sodium hypochlorite is diluted to a specified concentration (full strength 0.5%, half strength 0.25%, quarter strength 0.125%). Failure to dilute sodium hypochlorite may result in severe adverse events.
Due to the strong oxidizing property of sodium hypochlorite, skin irritation, erythema, edema, and pain may occur following topical administration. Instruct patients to discontinue therapy and seek medical advice if the above symptoms develop.
Do not use sodium hypochlorite topically if the patient is sensitive to chlorine compounds.
Diluted sodium hypochlorite solution is only approved for topical exposure to the skin. For external use only. Take measures to ensure sodium hypochlorite is not ingested and does not come into contact with the eyes. Accidental exposure or ingestion may require medical assistance; if swallowed, contact a poison control center or seek medical help. If ocular exposure occurs, rinse eyes thoroughly with water for at least 15 minutes and seek immediate medical attention. Additionally, the manufacturer recommends use of a moisture barrier or skin sealant during the application process to protect surrounding intact skin from accidental exposure. Undiluted sodium hypochlorite (bleach) should not be applied directly to the skin.
Data regarding the use of dilute sodium hypochlorite solution during pregnancy is not available; the irrigation is available for non-prescription use and no particular cautions are noted. Pregnant females should get appropriate medical advice before use. Use during pregnancy only if the potential benefit to the mother justifies any potential risk to the fetus.
Data regarding the use of dilute sodium hypochlorite solutions during breast-feeding are not available; the irrigation is available for non-prescription use and no particular cautions are noted. Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of untreated or inadequately treated condition. If a breast-feeding infant experiences an adverse reaction related to the maternally ingested drug, health care providers are encouraged to report the adverse effect to the FDA.
While dilute sodium hypochlorite solutions have been used topically in children for wound care management, it may be best to seek medical advice for proper wound treatment prior to non-prescription use. Keep the solutions out of reach of children. There are no specific data for infants or neonates; qualified medical advice is recommended before use topically on any infant.
For wound management including the treatment of skin and tissue infection and skin and tissue infection prophylaxis of skin abrasion, cut, or ulcer and/or pre- and post-surgically:
Topical dosage (solution):
Adults: Apply to the affected area(s) topically once daily for lightly to moderately exudative wounds or twice daily for heavily exudative or contaminated wounds.
Children and Adolescents: Apply to the affected area(s) topically once daily for lightly to moderately exudative wounds or twice daily for heavily exudative or contaminated wounds.
Topical dosage (gel):
Adults: Apply 0.25 to 0.5 inches of gel to the affected area(s) topically once daily. Reapply as necessary.
Maximum Dosage Limits:
-Adults
2 applications/day to each affected area topically.
-Geriatric
2 applications/day to each affected area topically.
-Adolescents
2 applications/day to each affected area topically.
-Children
2 applications/day to each affected area topically.
-Infants
No data available; it is prudent to seek qualified medical advice before use.
-Neonates
No data available; it is prudent to seek qualified medical advice before use.
Patients with Hepatic Impairment Dosing
No dosage adjustments are needed.
Patients with Renal Impairment Dosing
No dosage adjustments are needed.
*non-FDA-approved indication
There are no drug interactions associated with Sodium Hypochlorite products.
Sodium hypochlorite is a topical medication with antimicrobial and tissue dissolution properties. These pharmacologic properties are a result of three chemical reactions that occur following topical administration. The antimicrobial activity of sodium hypochlorite is a product of a chloramination reaction between the strong oxidant, chlorine, and the amino group (NH) from bacterial amino acids. Through this interaction, the sulfhydryl group (SH) on essential bacterial enzymes is oxidized, causing the enzyme to be irreversibly inhibited. During the second reaction, saponification, sodium hypochlorite degrades organic fatty acids into fatty acid salts (soap) and glycerol (alcohol). This reaction results in a decreased surface tension of the remaining solution. Finally in the last reaction, amino acids are neutralized by sodium hypochlorite to create salt and water.
Sodium hypochlorite is administered topically to the skin. No data regarding pharmacokinetics of sodium hypochlorite are available.