Hydrogen Peroxide (Monograph)

Drug class: Mouthwashes and Gargles
ATC class: S02AA06
VA class: OR500
CAS number: 7722-84-1

Medically reviewed by Drugs.com on Dec 23, 2024. Written by ASHP.

Introduction

Hydrogen peroxide is a source of nascent oxygen and a weak topical antibacterial agent.

Uses for Hydrogen Peroxide

Hydrogen peroxide 3% topical solution is used to cleanse minor cuts or skin abrasions. More potent solutions (e.g., 20–30%) have been used as a hair bleach.

Hydrogen peroxide is used as an oral topical gel or as a mouthwash or rinse to cleanse minor wounds or minor gum inflammation resulting from minor dental procedures, orthodontic appliances, denture irritations, accidental injury, and other mouth and gum irritations (e.g., canker sores).

Hydrogen Peroxide Dosage and Administration

Hydrogen peroxide solution is used topically as a 3% solution for cleansing minor cuts or abrasions.

Hydrogen peroxide oral topical solution (Peroxyl antiseptic oral cleanser) is used as a mouthwash or rinse; the commercially available 1.5% oral solution is used undiluted. For the management of minor mouth or gum irritation, 10 mL of the solution is swished around the mouth over the affected area for at least 1 minute before expectorating. The solution may be used up to 4 times daily (after meals and at bedtime) or as directed by a clinician. Hydrogen peroxide oral topical solution is for topical use only and should not be ingested. Children younger than 12 years of age should be supervised by an adult in the use of the oral solution; for use of this preparation in children younger than 2 years of age, a dentist or physician should be consulted.

Hydrogen peroxide gel (Peroxyl gel) is used topically as a 1.5% gel for cleansing minor wounds or irritations of the mouth or gums. A small amount of the gel is applied to the affected area, allowed to remain in place for at least 1 minute, and then expectorated; the gel may be used up to 4 times daily (after meals and at bedtime) or as directed by a dentist or physician. Children younger than 12 years of age should be supervised by an adult in the use of the gel; for use of the gel in children younger than 2 years of age, a dentist or physician should be consulted.

Cautions for Hydrogen Peroxide

The US Food and Drug Administration (FDA) has alerted consumers that high strength hydrogen peroxide preparations (e.g., 35% food grade hydrogen peroxide) should not be used for any medicinal purpose. These preparations are being promoted on websites illegally for various medicinal purposes (e.g., AIDS, cancer, emphysema, other life-threatening conditions) without any proven clinical value, and such uses are dangerous. Hydrogen peroxide 35% is not approved by the FDA for any purpose. Ingestion of such preparations can cause serious harm or death. Oral ingestion of hydrogen peroxide can result in GI irritation and ulceration. IV administration of hydrogen peroxide can result in inflammation at the injection site, gas embolism, and life-threatening allergic reactions.

Concentrated solutions (20–30% or more) of hydrogen peroxide are strongly irritating to skin or mucous membranes and should be handled cautiously.

For self-administration, hydrogen peroxide oral topical solution or gel should not be used for longer than 7 days, unless otherwise directed by a clinician. Repeated use of hydrogen peroxide topical solution as a mouthwash or gargle may produce a condition known as “hairy tongue” or may cause irritation of the buccal mucous membrane.

Pharmacology

Hydrogen peroxide topical solution is a weak antibacterial agent, a wound cleanser, and a deodorant. The pharmacologic activity of the drug depends on the release of nascent oxygen which has a powerful oxidizing effect that destroys some microorganisms and chemically alters many organic substances. When hydrogen peroxide topical solution comes in contact with tissues that contain the enzyme catalase, the solution releases oxygen which exerts antibacterial action; the mechanical effect of effervescence loosens tissue debris and pus. The release of nascent oxygen and effervescence is more rapid on wounds, denuded areas, and mucous membranes than on unbroken skin. The presence of reactive organic material such as pus and blood diminishes the efficiency of hydrogen peroxide. The antibacterial activity of hydrogen peroxide is relatively weak and slow and the drug exhibits poor tissue and wound penetration. Hydrogen peroxide’s mechanical effect of effervescence and resultant removal of tissue debris is probably a more effective means of reducing the bacterial content of wounds, denuded areas, and mucous membranes than actual antibacterial activity. The drug also appears to have a styptic effect when applied topically to minor wounds. Concentrated solutions of hydrogen peroxide have a bleaching effect on hair and may injure tissue.

Chemistry and Stability

Chemistry

Hydrogen peroxide is a weak topical antibacterial agent. Hydrogen peroxide topical solution contains 2.5–3.5 g of hydrogen peroxide per 100 mL and occurs as a clear, colorless liquid which is odorless or has an odor resembling ozone. Hydrogen peroxide concentrate contains 29–32% w/w hydrogen peroxide and occurs as a clear, colorless, caustic liquid. Hydrogen peroxide concentrate is a strong oxidant. Hydrogen peroxide topical solution and hydrogen peroxide concentrate may also contain up to 0.05% of a suitable preservative(s). Hydrogen peroxide topical solution is acidic to the taste and to litmus paper and produces a froth in the mouth; because hydrogen peroxide concentrate is caustic, it should not be tasted undiluted.

Potency of hydrogen peroxide is often described in terms of volume of active oxygen it yields. Each 1% w/w hydrogen peroxide is equivalent to 3.3% by volume; 100 volume hydrogen peroxide is approximately equivalent to 30% w/w, 30 volume to 9% w/w, and 10 volume to 3% w/w, respectively.

Stability

Hydrogen peroxide topical solution deteriorates upon standing or upon repeated agitation, undergoes accelerated decomposition when exposed to light or when in contact with many oxidizing or reducing substances, and decomposes suddenly when heated. Hydrogen peroxide topical solution should be stored in tight, light-resistant containers at 15–30°C. To ensure greater stability, the inside surfaces of containers should be as free as possible from rough points since these promote decomposition.

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

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