BENZALKONIUM BROMIDE
It has same properties as BENZALKONIUM CHLORIDE so click to BENZALKONIUM CHLORIDE for details.
Benzalkonium Chloride
Incompatible with soaps and other anionic surfactants. cit-
rates. iodides, nitrates, permanganates, salicylates, silver
salts, and tartrates. Incompatibilities have been demonstrated
with ingredients of some commercial rubber mixes or plas-
tics. Incompatibilities have also been reported with other sub-
stances including aluminium, cotton dressings, fluorescein
sodium, hydrogen peroxide, kaolin, hydrous wool fat, and
some sulphonamides.
Adverse Effects, Treatment, and Precautions
As for Cetrimide whose details are given below :
CETRIMIDE
Adverse Effects and Treatment
If ingested, cetrimide and other quaternary ammoni-
um compounds cause nausea and vomiting; strong
solutions may cause oesophageal damage and
necrosis. They have depolarising muscle relaxant
properties and toxic symptoms include dyspnoea
and cyanosis due to paralysis of the respiratory mus-
cles, possibly leading to asphyxia. Depression of the
CNS (sometimes preceded by excitement and con-
vulsions). hypotension. coma, and death may also
occur. Accidental intra-uterine or intravenous ad-
ministration may cause haemolysis.
At the concentrations used on the skin. solutions of
cetrimide and other quaternary compounds do not
generally cause irritation, but some patients become
hypersensitive to cetrimide after repeated applica-
tions. Cetrimide powder is reported to be irritant.
There have been rare reports of burns with concen-
trated solutions of cetrimide. Treatment of poison-
ing is symptomatic; demulcents may be given if
necessary but emesis and lavage should be avoided,
particularly if concentrated solutions have been in-
gested. CNS stimulants and cholinesterase inhibi-
tors are reported not to reverse paralysis due to
cetrimide intoxication although sympathomimetics
have been tried.
The fatal dose of quaternary ammonium compounds was es-
timated to be 1 to 3 g.
Adverse effects following irrigation with cetrimide solutions
in the treatment of hydatid cysts have included chemical peri-
tonitis , methaemoglobinaemia with cyanosis, and metabolic
acidosis .
Precautions
Prolonged and repeated applications of cetrimide to
the skin are inadvisable as hypersensitivity may oc-
cur. Contact with the eyes. brain, mining
middle ear should be avoided. Cetrimide should
be used in body cavities or as an enema.
Solutions of quaternary ammonium compound
should not be used for disinfection of soft
lenses.
Aqueous solutions of cetrimide or other quaternary
ammonium disinfectants may be susceptible to con-
tamination with micro-organisms. To reduce this
risk, a sterilised preparation should be used or
where necessary, solutions must be freshly prepared
at the recommended concentration and appropriate
measures should be taken to prevent contamination
during storage or dilution.
Cetrimide powder is irritant; it has been recommended
the nose and mouth should be protected by a mask when
working with the powder and eyes should be protected with
goggles.
Uses and Administration
Cetrimide is a quaternary ammonium antiseptic
with actions and uses typical of cationic surfactants.
These surfactants dissociate in aqueous solution into
a relatively lafge and complex cation, which is re
sponsible for the surface activity, and a smaller inac
tive anion. In addition to emulsifying and detergent
properties, quaternary ammonium compounds have
bactericidal activity against Gram-positive and at a
higher concentration, against some Gram-negative
bacteria. Some Pseudomonas spp. are particularly resistant as are
strains of Mycobacterium tuberculosis.
They are ineffective against bacterial spores.,have variable
antifungal activity and are effective against some viruses.
Quaternary ammonium compounds are most effec-
tive in neutral or slightly alkaline solution and their
bactericidal activity is appreciably reduced in acid
media; their activity is enhanced by alcohols.
Like other quaternary ammonium compounds, nota-
bly benzalkonium chloride, cetrimide has been em-
ployed for cleansing skin, wounds , and burns. For these
purposes it has been used as a O.1 to 1.0% aqueous
solution, generally prepared by dilution of a more
concentrated solution, or as a cream containing
0.5%. However, a mixture of cetrimide with chio-
rhexidine has often been preferred to cet-
rimide alone. This combination is also used in a
lotion for acne .
Solutions containing up to 10% of cetrimide have
been used as shampoos to remove the scales in seb-
orrhocic dermatitis .
Cetrimide solution 0.5 or 1% has been used as a
scolicide to irrigate hydatid cysts during surgery
but systemic adverse effects have been reported (see above).
Cetrimide and benzalkonium chloride are also used
as preservatives in cosmetics and pharmaceutical
formulations including eye drops and in disinfecting
solutions for hard contact lenses; neither compound
should be used for disinfection of soft contact lens-
es.
Quaternary ammonium compounds are not reliable
agents for sterilising surgical instruments and heat-
labile articles.
Cetrimide is also present in some emulsifying prep-
arations such as Cetrimide Emulsifying Ointment .
BENZALKONIUM BROMIDE :
Effects on the eyes. Benzalkonium chloride is one of the
most disruptive ophthalmic additives to the stability of the li-
pid film and to corneal epithelial membranes; it has been
shown to be toxic to the eyes of rabbits but less so to the eyes
of humans. Toxicity experiments have tended to be carried
out using relatively high concentrations of benzalkonium
chloride but deleterious effects on the tear film and corneo-
conjunctival surface have been noted in patients receiving
regular long-term treatment for glaucoma with eye drops pre-
served with benzalkonium chloride in usual concentrations.
However, the use of preservatives in eye drops should gener-
ally be avoided and the formulation of such preparations in
single-dose containers is desirable.l2 Benzalkonium chloride
is not suitable for use in solutions employed in storing and
washing hydrophilic soft contact lenses, as it can bind to the
lenses and may later produce ocular toxicity when the lenses
are worn.
Effects on the respiratory tract. A hypersensitivity reac-
tion in one patient to benzalkonium chloride used as a pre-
servative in nose drops was confirmed by challenge which
produced nasal congestion and irritation of the eyes and throat
lasting 48 hours. Benzalkonium chloride used as a preserva-
tive in nebulised solutions of anti-asthma agents has been re-
ported to cause dose-related bronchoconstriction especially in
asthmatic patients and has been associated with the precipi-
tation of respiratory arrest in one patient.
Uses and Administration
Benzalkonium chloride is a quaternary ammonium
antiseptic and disinfectant with actions and uses
similar to those of the other cationic surfactants (see
Cetrimide. It is also used as an antimicrobi-
al preservative for pharmaceutical products. Benza-
lkonium bromide and benzalkonium saccharinate
have also been used.
Solutions of benzalkonium chloride 0.01 to 0.1%
are used for cleansing skin, mucous membranes, and
wounds. More dilute solutions of 0.005% are suita-
ble for irrigation of deep wounds. A 0.02 to 0.05%
solution has been used as a vaginal douche. An
aqueous solution containing 0,005 to 0.02% has
been used for irrigation of the bladder and urethra
and a 0.0025 to 0.005% solution for retention lavage
of the bladder.
Creams containing benzalkonium chloride are used
in the treatment of napkin rash and other derma-
toses.
A 0.2 to 0.5% solution has been used as a shampoo
in seborrhoeic dermatitis.
Lozenges containing benzalkonium chloride are
used for the treatment of superficial infections of the mouth and
throat. A 0.01 to 0.02% solution of benzalkonium chloride
is used as a preservative for some eye drops. It is not
suitable for eye drops containing local anaesthetics
as it accelerates their dehydrating effect. Because
some rubbers are incompatible with benzalkonium
chloride the BPC 1973 recommended that, unless
the suitability has been established, silicone rubber
teats be used on eye drop containers, Benzalkonium
chloride is used for disinfecting rigid contact lenses
but is unsuitable as a preservative in solu-
tions for washing and storing hydrophilic soft con-
tact lenses (see also Adverse Effects, above).
Benzalkonium chloride is also used as a spennicide.
solutions of 0.13% are used for disinfection and
storage of surgical instruments, sometimes with the
addition of sodium nitrite to inhibit rust.
Action. The antibacterial effect of benzalkonium chloride
0.003% was enhanced by 0.175% of benzyl alcohol, phenyl-
propanol or phenethyl alcohol.
Catheter-related sepsis. Benzalkonium chloride has been
investigated' for incorporation into catheters to reduce
catheter-related sepsis .
Disinfection. VIRUSES. Benzalkonium chloride inactivates
HIV and HSV in vitro. This property may contribute to the
prevention of sexually transmitted disease when benzalko-
nium is used as a spermicide.