MEDICATION SAFETY ISSUES
Sound-alike/look-alike issues:
Benza® may be confused with Benzac®
U.S. BRAND NAMES — HandClens® [OTC]; Pedi-Pro®; Pronto® Plus Lice Egg Remover Kit [OTC]; Zephiran® [OTC]
PHARMACOLOGIC CATEGORY
Antibiotic, Topical
DOSING: ADULTS — Topical:
Antiseptic (Pronto® Plus Lice Egg Remover Kit [benzalkonium chloride 0.1% solution]): Topical: Apply topically to clean affected area after shampooing with a lice killing shampoo.
Antiseptic on skin, mucous membranes, or wounds (Zephiran® [benzalkonium chloride solution 1:750]): Topical: The following is a guide for appropriate concentrations, depending on intended use and application site:
Bladder and urethral irrigation: Aqueous solution 1:5000 to 1:20,000.
Bladder retention lavage: Aqueous solution 1:20,000 to 1:40,000.
Breast and nipple hygiene: Aqueous solution 1:1000 to 1:2000.
Denuded skin and mucous membranes: Aqueous solution 1:5000 to 1:10,000.
Eye irrigation: Aqueous solution 1:5000 to 1:10,000.
Irrigation of deep, infected wounds: Aqueous solution 1:3000 to 1:20,000.
Oozing and open infections: Aqueous solution 1:2000 to 1:5000.
Postepisiotomy care: Aqueous solution 1:5000 to 1:10,000.
Preoperative preparation of skin (unbroken): Aqueous solution 1:750.
Preservation of ophthalmic solutions: Aqueous solution 1:5000 to 1:7500.
Surgeons’ hands and arms soaks: Aqueous solution 1:750.
Vaginal douche and irrigation: Aqueous solution 1:2000 to 1:5000.
Wet dressings by irrigation or open dressing (do not use in occlusive dressings): Aqueous solution ≤ 1:5000.
DOSING: PEDIATRIC — Antiseptic: Children ≥ 2 years: Topical (Pronto® Plus Lice Egg Remover Kit ([benzalkonium chloride 0.1% solution]): Refer to adult dosing.
DOSING: ELDERLY — Refer to adult dosing.
DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Lotion, topical [foam]:
HandClens®: 0.13% (50 mL, 240 mL, 1800 mL)
Lotion, topical [spray]:
HandClens®: 0.13% (15 mL)
Powder, topical:
Pedi-Pro®: 1% (60 g)
Solution, topical:
Pronto® Plus Lice Egg Remover Kit: 0.1% (60 mL)
Zephiran®: 1:750 (240 mL, 3840 mL) [aqueous]
DOSAGE FORMS: CONCISE
Lotion, topical [foam]:
HandClens®: 0.13% (50 mL, 240 mL, 1800 mL)
Lotion, topical [spray]:
HandClens®: 0.13% (15 mL)
Powder, topical:
Pedi-Pro®: 1% (60 g)
Solution, topical:
Pronto® Plus Lice Egg Remover Kit: 0.1% (60 mL)
Zephiran® [OTC]: 1:750 (240 mL, 3840 mL)
GENERIC EQUIVALENT AVAILABLE — No
ADMINISTRATION
Pronto® Plus Lice Egg Remover Kit (benzalkonium chloride 0.1% solution): For external use only; do not use in the eyes or over large areas of the body. Do not use for >1 week. Use to clean affected area after shampooing with a lice killing shampoo. Apply until the hair and scalp is thoroughly wet with product; cover the area behind the ears and at the nape of the neck; leave product in hair for 3 minutes before combing. Use toothed comb to comb out dead lice and their eggs. After each section has been combed out, rinse hair thoroughly with warm water.
Zephiran® (benzalkonium chloride solution 1:750): Further dilution may be required; appropriate dilutions should be made prior to use. Solutions intended for use on deep wounds or for irrigation of body cavities should be diluted with sterile water for injection. All other dilutions should be done using freshly distilled water. Tap water should not be used for dilutions; tap water may contain metallic ions and organic matter which may reduce antibacterial potency.
COMPATIBILITY — Incompatible with BAC solutions: Aluminum, caramel, fluorescein, iodine, kaolin, lanolin, nitrates, pine oil, peroxide, potassium permanganate, silver nitrate, yellow mercuric oxide, zinc oxide, zinc sulfate
USE — Antiseptic of skin, mucous membranes, and wounds; surface antiseptic; germicidal preservative
ADVERSE REACTIONS SIGNIFICANT — Frequency not defined.
Miscellaneous: Hypersensitivity (rare)
CONTRAINDICATIONS — Zephiran®: Use in occlusive dressings, casts, or in anal or vaginal packs (due to potential for irritation or chemical burns)
WARNINGS / PRECAUTIONS
Dosage form specific issues:
Pronto® Plus: For external use only; do not use in the eyes or over large areas of the body. Do not use for >1 week. Call healthcare provider if condition persists or worsens.
Zephiran®: Benzalkonium chloride (BAC) does not destroy bacterial spores and certain viruses, including infectious hepatitis; do not use to provide complete sterilization. Prior to application, further dilutions may be required depending on use and application site; BAC solutions applied to inflamed skin/ irritated tissues must be more dilute than concentrations used on normal tissues. BAC solutions >1:3000 should not enter the eyes; irrigate with water immediately and repeatedly; prompt medical attention should follow. BAC solutions >1:5000 should not be used on mucous membranes (except the vaginal mucosa). Organic, inorganic, and synthetic materials and surfaces may adsorb significant amounts of BAC, decreasing potency of the solution. Materials used to apply solution (eg, gauze sponges, fiber pledgets) should only be soaked in BAC solution immediately prior to application. If soaps or anionic detergents are used, rinse thoroughly prior to application of BAC to avoid a decrease in potency of BAC.
DRUG INTERACTIONS — There are no known significant interactions.
INTERNATIONAL BRAND NAMES — Agena (IT); Ajatin (CZ); Alfa C (IT); Armil (ES); Armil Concentrado (ES); Asepsol (HR); Baktonium (DE); Benzalc (ES); Benzalconio Cloruro (IT); Benzalcream (AR); Benzaltex (CH); Bradosol (GB); Callusolve (GB); Capitol (GB); Cedium (BE, LU); Citrosil (IT); Colli (IT); Collirium Geymonat (IT); Contusil (IT); Crema Contracepti Lanzas (ES); Dimill (IT); Disintyl (IT); Display (IT); Disteril (IT); Flexoygne (FR); Geyderm (IT); Hamamilla (IT); Herbe (IT); Inhivirus (AR); Ionax (GB, IE); Ionax Scrub (GB); Iridina Light (IT); Lacribase (IT); Laudamonium (DE); Lozione Vittoria Ottolenghi (IT); Lysoform Killavon (DE); Mini Ovulo Lanzas (ES); Nasimild (AT); Neo-Desogen (IT); Neomedil (IT); Novamina (ES); Oftan (FI); Otazul Collirio (IT); Pharmatex (AR, BE, FR, LU, PT); Pupilla Light (IT); Rashfree (IN); Rheila Stringiet N (DE, LU); Roccal (GB, IE); Sagrotan Med (DE); Sangen (IT); Saquat (IT); Sguardi (IT); Sirigen (IT); Sparaplaie (FR); Steramina (IT); Steramina G (IT); Sterilix (IT); Stilla Delicato (IT); Video-light (IT)