MEDICATION SAFETY ISSUES
Sound-alike/look-alike issues:
Benzoyl peroxide may be confused with benzyl alcohol
Benoxyl® may be confused with Brevoxyl®, Peroxyl®
Benzac® may be confused with Benza®
Brevoxyl® may be confused with Benoxyl®
Fostex® may be confused with pHisoHex®
SPECIAL ALERTS
Benzoyl Peroxide 10% Acne Products: Recall Prompted by Bacteria Contamination – November 2008
Certain products of benzoyl peroxide have been recalled because samples of the products were found to contain Burkholderia cepacia (formerly known as Pseudomonas cepacia) which may increase the risk of infection in patients with compromised skin conditions or immunosuppressed patients.
For additional information on products affected, please refer to the FDA MedWatch alert: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm126436.htm
U.S. BRAND NAMES — 10 Benzagel®; 5 Benzagel®; Acne Clear Maximum Strength [OTC]; Benzac® AC; BenzaShave®; Benziq™ ; Benziq™ LS; Brevoxyl®; Brevoxyl® Acne Wash Kit [DSC]; Brevoxyl®-4; Brevoxyl®-8; breze™ [DSC]; Clearskin [OTC]; Clinic BPO; Desquam-E™ [DSC]; Desquam-X®; EthexDERM™ BPW-10 [DSC]; EthexDERM™ BPW-5 [DSC]; Inova™ ; NeoBenz® Micro SD [DSC]; NeoBenz® Micro Wash; NeoBenz® Micro [DSC]; Neutrogena® Body Clear® [OTC]; Neutrogena® Clear Pore™ [OTC]; Neutrogena® Oil-Free Acne Wash [OTC]; Neutrogena® On The Spot® Acne Treatment [OTC]; Pacnex™ ; Palmer’s® Skin Success Invisible Acne [OTC]; PanOxyl® Aqua Gel; PanOxyl® Bar [OTC]; Triaz®; Zapzyt® [OTC]; Zoderm®; Zoderm® Hydrating Wash™ ; Zoderm® Redi-Pads™
PHARMACOLOGIC CATEGORY
Acne Products
Topical Skin Product
Topical Skin Product, Acne
DOSING: ADULTS — Acne: Topical:
Cleansers: Wash once or twice daily; control amount of drying or peeling by modifying dose frequency or concentration
Lotion: Apply sparingly once daily; gradually increase to 2-3 times/day if needed. If excessive dryness or peeling occurs, reduce dose frequency or concentration. If excessive stinging or burning occurs, remove with mild soap and water; resume use the next day.
DOSING: PEDIATRIC — Adolescents: Refer to adult dosing.
(For additional information see “Benzoyl peroxide: Pediatric drug information”)
DOSING: ELDERLY — Refer to adult dosing.
DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Bar, topical [wash]:
PanOxyl® Bar: 5% (113 g); 10% (113 g)
Zapzyt®: 10% (113 g)
Cream, topical:
BenzaShave®: 5% (120 g); 10% (120 g) [contains sodium coconut sulfate and coconut acid]
Clearskin: 10% (28 g)
NeoBenz® Micro: 3.5% (45 g) [DSC]; 5.5% (45 g) [DSC]; 8.5% (45 g) [DSC]
NeoBenz® Micro SD: 3.5% (0.5 g) [DSC]; 5.5% (0.5 g) [DSC]; 8.5% (0.5 g) [DSC]
Neutrogena® On The Spot® Acne Treatment: 2.5% (22.5 g) [vanishing and tinted formulas]
Zoderm®: 4.5% (125 mL) [contains urea 10%]; 6.5% (125 mL) [contains urea 10%]; 8.5% (125 mL) [contains urea 10%]
Cream, topical [cleanser, mask]:
Neutrogena® Clear Pore™ : 3.5% (125mL)
Gel, topical: 5% (45 g, 60 g); 10% (42.5 g, 45 g, 60 g, 90 g)
5 Benzagel®: 5% (45 g) [contains ethanol 14%]
10 Benzagel®: 10% (45 g) [contains ethanol 14%]
Acne Clear Maximum Strength: 10% (42.5 g)
Brevoxyl®-4: 4% (42.5 g)
Brevoxyl®-8: 8% (42.5 g)
Clearplex: 5% (45 g); 10% (45 g)
Clinic™ BPO: 7% (45 g)
Desquam-X®: 5% (42.5 g, 90 g) [DSC]; 10% (42.5 g, 90 g)
Neutrogena® Oil-Free Acne Wash: 2% (177 mL) [contains tartrazine]
Zapzyt®: 10% (30 g)
Zoderm®: 4.5% (125 mL) [contains urea 10%]; 6.5% (125 mL) [contains urea 10%]; 8.5% (125 mL) [contains urea 10%]
Gel, topical [alcohol-based]: 5% (60 g); 10% (60 g)
Triaz®: 3% (170 g, 340 g); 6% (170 g, 340 g); 9% (170 g, 340 g)
Gel, topical [wash]: 5% (150 g, 240 g); 10% (150 g, 240 g)
Gel, topical [water-based]: 2.5% (60 g; 5% (60 g, 90 g); 10% (60 g, 90 g)
Benzac® AC: 5% (60 g); 10% (60 g)
Benziq™ : 5.25% (50 g) [contains aloe, benzyl alcohol]
Benziq™ LS: 2.75% (50 g) [contains aloe, benzyl alcohol]
Desquam-E™ : 2.5% (42.5 g) [DSC]; 5% (42.5 g) [DSC] [emollient gel]
PanOxyl® Aqua Gel: 10% (42.5 g)
Liquid, topical:
Desquam-X®: 5% (150 mL)
Liquid, topical [body wash]: 5.75% (473 mL)
Neutrogena® Body Clear®: 2% (250 mL) [contains tartrazine]
Liquid, topical [wash]: 2.5% (240 mL); 5% (120 mL, 150 mL, 240 mL); 10% (150 mL, 240 mL)
Zoderm® Hydrating Wash™ : 5.75% (473 mL) [contains urea 10%]
Liquid, topical [wash/water-based]:
Benzac® AC: 10% (240 mL)
Benzac® W: 5% (240 mL); 10% (240 mL)
Benziq™ : 5.25% (175 g) [contains aloe, benzyl alcohol]
EthexDERM™ BPW-5: 5% (240 mL) [DSC]
EthexDERM™ BPW-10: 10% (240 mL) [DSC]
Lotion, topical: 5% (30 mL); 10% (30 mL)
Palmer’s® Skin Success Invisible Acne: 10% (30 mL) [contains vitamin E and aloe]
Lotion, topical [wash]: 4% (170 g); 5% (227 g); 8% (170 g); 10% (227 g)
Brevoxyl® Acne Wash Kit: 4%; 8% [kit includes SFC™ Lotion] [DSC]
NeoBenz® Micro Wash: 7% (180 g)
Pacnex™ : 7% (454 g) [contains aloe]
Pad, topical:
breze™ : 4.75% (30s), 7.75% (30s) [DSC]
Inova™ : 4% (30s); 8% (30s)
Triaz®: 3% (30s, 60s); 6% (30s, 60s); 9% (30s)
ZoDerm®: 4.5% (30s); 6.5% (30s); 8.5% (30s) [contains urea 10%]
Soap, topical [cleanser/emulsion-based]:
ZoDerm®: 4.5% (400 mL); 6.5% (400 mL); 8.5% (400 mL) [contains urea 10%]
DOSAGE FORMS: CONCISE
Bar, topical [wash]:
PanOxyl® Bar [OTC]: 5% (113 g); 10% (113 g)
Zapzyt® [OTC]: 10% (113 g)
Cream, topical:
BenzaShave®: 5% (120 g); 10% (120 g)
Clearskin [OTC]: 10% (28 g)
Neutrogena® On The Spot® Acne Treatment [OTC]: 2.5% (22.5 g)
Zoderm®: 4.5% (125 mL); 6.5% (125 mL); 8.5% (125 mL)
Cream, topical [cleanser, mask]:
Neutrogena® Clear Pore™ [OTC]: 3.5% (125mL)
Gel, topical: 5% (45 g, 60 g); 10% (42.5 g, 45 g, 60 g, 90 g)
5 Benzagel®: 5% (45 g)
10 Benzagel®: 10% (45 g)
Acne Clear Maximum Strength [OTC]: 10% (42.5 g)
Brevoxyl®-4: 4% (42.5 g)
Brevoxyl®-8: 8% (42.5 g)
Clearplex: 5% (45 g); 10% (45 g)
Clinic BPO: 7% (45 g)
Desquam-X®: 10% (42.5 g, 90 g)
Neutrogena® Oil-Free Acne Wash [OTC]: 2% (177 mL)
Zapzyt® [OTC]: 10% (30 g)
Zoderm®: 4.5% (125 mL); 6.5% (125 mL); 8.5% (125 mL)
Gel, topical [alcohol-based]: 5% (60 g); 10% (60 g)
Triaz®: 3% (170 g, 340 g); 6% (170 g, 340 g); 9% (170 g, 340 g)
Gel, topical [wash]: 5% (150 g, 240 g); 10% (150 g, 240 g)
Gel, topical [water-based]: 2.5% (60 g; 5% (60 g, 90 g); 10% (60 g, 90 g)
Benzac® AC: 5% (60 g); 10% (60 g)
Benziq™ : 5.25% (50 g)
Benziq™ LS: 2.75% (50 g)
PanOxyl® Aqua Gel: 10% (42.5 g)
Liquid, topical:
Desquam-X®: 5% (150 mL)
Liquid, topical [body wash]: 5.75% (473 mL)
Neutrogena® Body Clear® [OTC]: 2% (250 mL)
Liquid, topical [wash]: 2.5% (240 mL); 5% (120 mL, 150 mL, 240 mL); 10% (150 mL, 240 mL)
Zoderm® Hydrating Wash™ : 5.75% (473 mL)
Liquid, topical [wash/water-based]:
Benzac® AC: 10% (240 mL)
Benziq™ : 5.25% (175 g)
Lotion, topical: 5% (30 mL); 10% (30 mL)
Palmer’s® Skin Success Invisible Acne [OTC]: 10% (30 mL)
Lotion, topical [wash]: 4% (170 g); 5% (227 g); 8% (170 g); 10% (227 g)
NeoBenz® Micro Wash: 7% (180 g)
Pacnex™ : 7% (454 g)
Pad, topical:
Inova™ : 4% (30s); 8% (30s)
Triaz®: 3% (30s, 60s); 6% (30s, 60s); 9% (30s)
ZoDerm®: 4.5% (30s); 6.5% (30s); 8.5% (30s)
Soap, topical [cleanser/emulsion-based]:
ZoDerm®: 4.5% (400 mL); 6.5% (400 mL); 8.5% (400 mL)
GENERIC EQUIVALENT AVAILABLE — Yes: Excludes cream, pads, and soap
USE — Adjunctive treatment of mild-to-moderate acne vulgaris and acne rosacea
ADVERSE REACTIONS SIGNIFICANT — 1% to 10%: Dermatologic: Irritation, contact dermatitis, dryness, erythema, peeling, stinging
DRUG INTERACTIONS — There are no known significant interactions.
PREGNANCY RISK FACTOR — C (show table)
PRICING — (data from drugstore.com)
Cream (Benzashave)
5% (113.4): $83.18
10% (113.4): $87.73
Cream (NeoBenz Micro)
3.5% (45): $126.24
5.5% (45): $126.24
8.5% (45): $129.46
Cream (NeoBenz Micro SD)
3.5% (30): $187.48
5.5% (30): $187.48
Cream (Zoderm)
4.5-10% (125): $213.91
Gel (Benzac AC)
2.5% (60): $21.99
5% (60): $75.87
10% (60): $80.71
Gel (Benzac W)
2.5% (60): $20.99
5% (60): $21.99
10% (60): $21.99
Gel (Benzagel Wash)
10% (60): $26.03
Gel (Benziq)
5.25% (50): $91.65
Gel (Benziq LS)
2.75% (50): $87.32
Gel (Benzoyl Peroxide)
5% (45): $12.99
5% (90): $21.99
10% (45): $13.99
10% (60): $24.99
10% (90): $28.99
Gel (Brevoxyl)
4% (42.5): $101.33
8% (42.5): $101.44
Gel (Clinac BPO)
7% (45): $77.99
Gel (Desquam-E)
2.5% (42.5): $21.99
5% (42.5): $22.99
10% (42.5): $16.99
Gel (Panoxyl Aqua)
10% (42.5): $8.99
Gel (Seba-Gel)
10% (60): $21.99
10% (90): $26.40
Gel (Zoderm)
4.5-10% (125): $214.45
Kit (Benzoyl Peroxide Creamy Wash)
4% (1): $59.99
8% (1): $69.99
Kit (Brevoxyl-4 Acne Wash)
4% (1): $79.79
Liquid (Benzac AC Wash)
2.5% (240): $30.98
5% (226): $109.09
10% (226): $117.79
Liquid (Benzac W Wash)
5% (226): $106.20
10% (226): $121.43
Liquid (Benziq Wash)
5.25% (175): $88.76
Liquid (Benzoyl Peroxide Creamy Wash)
4% (170.1): $34.99
Liquid (Benzoyl Peroxide Wash)
5% (142): $21.99
Liquid (Zoderm)
5.75-10% (473): $183.34
Liquid (Zoderm Cleanser)
4.5-10% (400): $142.12
6.5-10% (400): $146.08
8.5-10% (400): $154.28
Lotion (Triaz Cleanser)
3% (170.3): $83.24
3% (340.2): $145.13
6% (170.3): $84.50
6% (340.2): $149.59
9% (170.3): $94.09
9% (340.2): $155.23
Pads (Triaz)
3% (30): $149.62
3% (60): $282.28
6% (30): $149.62
6% (60): $282.28
9% (30): $149.62
Pads (Zoderm)
4.5-10% (30): $166.81
6.5-10% (30): $161.04
CANADIAN BRAND NAMES — Acetoxyl®; Benoxyl®; Benzac AC®; Benzac W® Gel; Benzac W® Wash; Desquam-X®; Oxyderm™ ; PanOxyl®; Solugel®
INTERNATIONAL BRAND NAMES — Acne Derm (IL); Acnecide (IE); Acnetick-10 (CO); Acnexyl (TH); Acnie (TW); Aczee (TH); Aknefug (EE); Aknefug-oxid (PL); Akneroxid (AT, BE, CH, CZ, DE, HN, HU, LU, NL, PL, SG); Ambix (PL); Antopar (HR, PL); Basiron (CZ, DK, FI, NO); Basiron AC (SE); Benoxid (IT); Benoxyl (AE, BB, BF, BH, BJ, BM, BR, BS, BZ, CI, CY, EG, ET, GB, GH, GM, GN, GY, IL, IQ, IR, JM, JO, KE, KW, LB, LR, LY, MA, ML, MR, MU, MW, NE, NG, OM, PH, PR, QA, SA, SC, SD, SL, SN, SR, SY, TN, TT, TZ, UG, VE, YE, ZA, ZM, ZW); Benoxyl AQ AL (MX); Benzac (AU, IL, IT, LU, PT); Benzac AC (AU, CO, HK, MX, MY, NZ, PE, PH, SG, TH, TW, VE); Benzac MR AC (CR, DO, GT, HN, NI, PA, SV); Benzac W (AU, BB, BM, BS, BZ, CN, GR, GY, JM, MX, PR, SR, TT); Benzacne (PL); Benzapur (PL); Benzihex (AR, CL); Benzihex AC (PY, UY); Benzoile Perossido (IT); Benzolac (ID); Benzomix (IT); Benzoylperoxide-Galderma (LU); Benzperox (BG); Bexid (SE); Brevoxyl (AU, CH, DE, FI, FR, PK, PL, SE, SG, TW); Clearasil Ultra (IT, PL); Eclaran (FR, LU); Ecuaderm (VE); Effacne (FR, LU); Enzoxid (TH); Lubexyl (PL); Medigel (PL); Oxiderma (ES); Oxy (BR, HU, PL, SE); Oxy Preps. (AU); Pangel (BE); Panoxyl (AE, AT, BB, BH, BM, BR, BS, BZ, CY, DE, EG, FR, GB, GY, HK, IE, IL, IQ, IR, IT, JM, JO, KW, LB, LU, LY, MY, NO, OM, PH, QA, SA, SR, SY, TH, TT, TW, YE, ZA); PanOxyl (AU); Pansulfox (CN); Pernox Gel (IN); Peroxiben (PT); Persol Gel (IN); Reloxyl (IT); Scherogel (AT, IT, LU); Stioxyl (SE); Tinagel (LU); Vixiderm (AR)
MECHANISM OF ACTION — Releases free-radical oxygen which oxidizes bacterial proteins in the sebaceous follicles decreasing the number of anaerobic bacteria and decreasing irritating-type free fatty acids
PHARMACODYNAMICS / KINETICS
Absorption: ~5% via skin; gel more penetrating than cream
Metabolism: Converted to benzoic acid in skin