Hydrogen Peroxide
Aqueous solutions of hydrogen peroxide gradually decom-
- pose on standing and if allowed to become alkaline. Decom-
position is increased by light, agitation, and heat.
Incompatibility may also produce decomposition. Hydrogen
peroxide solutions are incompatible with reducing agents,
including organic matter and oxidisable substances, and with
some metals, metallic salts, alkalis, iodides, permanganates,
and other stronger oxidising agents. Solutions are compara-
tively stable in the presence of a slight excess of acid. Strong
solutions are considered to be more stable than weak solu-
tions.
Solutions of hydrogen peroxide should be stored in airtight
containers at 15Β° to 30Β° (but see Hydrogen Peroxide Solution
(30 per cent), below). Solutions should not be stored for long
periods. Those not containing a stabiliser should be stored at
a temperature not exceeding 15Β°. Protect from light.
Adverse Effects and Precautions
Strong solutions of hydrogen peroxide produce irri-
tating 'bums' on the skin and mucous membranes
with a white eschar, but the pain disappears in about
an hour. Continued use of hydrogen peroxide as a
mouthwash may cause reversible hypertrophy of the
papillae of the tongue.
It is dangerous to inject or instill hydrogen peroxide
into closed body cavities from which the released
oxygen has no free exit. Coionic lavage with solu-
tions of hydrogen peroxide has been followed by gas
embolism, rupture of the colon, proctitis, ulcerative
colitis, and gangrene of the intestine.
Closed body cavities. Liberation of oxygen during the use
of hydrogen peroxide in surgical procedures has resulted in
oxygen embolism and local emphysema. Gas embolism
has also been reported after accidental ingestion of hydrogen
peroxide solution. Local damage to the coionic and rectal
mucosa has followed the use of hydrogen peroxide as an
enema and from residual hydrogen peroxide following disin-
fection of endoscopes.
Effects on the eyeΒ». Hydrogen peroxide, in a concentration
as low as 30 ppm, caused damage to human corneal epithelial
cells in vitro-, concentrations of 70 to 100 ppm caused cell
death within minutes.'
Intravascular administration. Intravenous administration
of hydrogen peroxide solutions as unconventional therapy for
AIDS or cancer has resulted in severe acute haemolysis.
Haemolysis was also reported following contamination of
haemodialysis fluid with hydrogen peroxide.
Uses and Administration
Hydrogen peroxide is an oxidising agent used as an
antiseptic, disinfectant, and deodorant. It has weak
antibacterial activity and is also effective against vi-
ruses. including HIV. It also has a mild haemostatic
action. It owes its antiseptic action to its ready re-
lease of oxygen when applied to tissues, but the ef-
fect lasts only as long as the oxygen is being
released and is of short duration; in addition the an-
timicrobial effect of the liberated oxygen is reduced
in the presence of organic matter. The mechanical
effect of effervescence is probably more useful for
wound cleansing than the antimicrobial action (but
see p. 1098).
Hydrogen peroxide solutions are used to cleanse
wounds and ulcers in concentrations of up to 6%;
creams containing 1% or 1.5% stabilised hydrogen
peroxide are also used. Although hydrogen peroxide
alone is not considered effective on intact skin, it is
used in combination with other antiseptics for the
disinfection of hands, skin, and mucous membranes.
Injection into closed body cavities is dangerous (see
above). Adhering and blood-soaked dressings may
be released by the application of a solution of hydro-
gen peroxide.
A 1.5% solution of hydrogen peroxide has been
used as a mouthwash in the treatment of acute sto-
matitis and as a deodorant gargle. A suitable solu-
tion can be prepared by diluting 15 mL of hydrogen
peroxide 6% in half a tumblerful of warm water. An
oral gel has also been used.
Hydrogen peroxide ear drops have been used for the
removal of wax. Such ear drops were prepared by
diluting a 6% solution of hydrogen peroxide with 3
parts of water preferably just before use.
Hydrogen peroxide 3% is used for disinfecting soft
contact lenses.
Immersion for 30 minutes in hydrogen peroxide 6%
has been suggested for disinfecting cleaned equip-
ment.
For bleaching hair and delicate fabrics hydrogen
peroxide 6% should be diluted with an equal volume
of water.
Strong solutions (27 per cent and 30 per cent) of hy-
drogen peroxide are used for the preparation of
weaker solutions and should not be applied to tis-
sues undiluted.
Hydrogen peroxide and other peroxides have many
industrial uses as bleaching and oxidising agents.
Disinfection. CONTACT LENSES. Hydrogen peroxide 3% is
particularly useful for disinfecting soft contact lenses
and lens storage cases since it is effective against
Actolthanweba spp. However, it is irritant to the cornea (see
under Adverse Effects, above) and requires inactivating with
sodium pyruvate, catalase, or sodium thiosulphate before the
lenses are used.
DIALYSIS EQUIPMENT. A disinfectant containing hydrogen per-
oxide and peracetic acid (Renalin) was not completely effec-
tive in killing Mycobacterum chelonae in high-flux dialysers.
This possibly led to infection of 5 dialysis patients.' For a re-
port of haemolysis following inadvertent contamination of di-
alysis fluid with hydrogen peroxide, see Intravascular
Administration, under Adverse Effects and Precautions.
above.
ENDOSCOPES. Peroxygen compounds have been suggested for
disinfection of endoscopes as an alternative to glutaraldehyde.
Hydrogen peroxide solution 3% is fully effective
against oocysts of Cryptosporidium and immersion for 30
minutes at room. temperature has been recommended. How-
ever, it has been pointed out that hydrogen peroxide damages
external surfaces, particularly rubbers and plastics of the in-
sertion tubes, and thus is not ideal for such purposes. Other
peroxygen-containing compounds have been assessed for dis-
infecting endoscopes but their activity against enteroviruses
and mycobacteria may be inadequate.-~ Residual hydrogen
peroxide solution can cause mucosal damage (see above) and
endoscopes should be thoroughly rinsed before use.
Mouth ulceration and Infection. The use of antiseptic
mouthwashes may be helpful in the management of mouth
ulcers ,although the use of hydrogen peroxide 3% is
not advisable. However, application of a 1.5% solution to in-
dividual ulcers in combination with a topical corticosteroid
may be useful. For oral candidal infections, specific antifim-
gals are recommended , and a hydrogen peroxide
denture cleaner was not effective in either preventing re-
infection or in reducing mucosal inflammation in a study of
49 patients. Sec also Adverse Effects on the Mouth, above.