Carbamide peroxide toxicity
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The bottom line
Carbamide peroxide is commonly used as an ear wax removal agent, oral rinse, and teeth-whitener. Highly concentrated products can cause serious burns. Life-threatening toxicity can occur when carbamide peroxide comes into contact with open wounds or if large amounts are swallowed, forming oxygen bubbles that block blood flow to tissue.
Prevention tips
Keep these products out of reach of children.
Follow the package instructions .
Consult a doctor before using it in children under 12 years of age.
If using carbamide peroxide for ear wax removal, do not use it for more than 4 days at a time.
Do not use it in the ear if you have pain, drainage, discharge, or a rash in the ear.
Do not use it if in. the ear you have had recent ear surgery.
Do not use it for more than 7 days as an oral rinse.
Use carbamide peroxide for a shorter time or skip days if you experience tooth sensitivity when using it for teeth whitening.
This really happened
Case 1. A 54-year-old woman unintentionally put ear wax solution containing carbamide peroxide into her eye. Fifteen minutes later, she called the local Emergency Medical Services (EMS) to her home. Her eye was swollen, red, and irritated. She rinsed her eye with water for about 7 minutes before EMS called a poison center. The poison center instructed them to continue irrigating her eyes with water for a total of 15 minutes. One hour later, she still had eye irritation and redness. She was referred to an emergency department for medical evaluation where they found no injury to the cornea. On follow-up the following day, her symptoms had resolved on their own.
Case 2. A mother called her poison center after accidentally putting carbamide peroxide ear drops instead of a prescription eye drop medication into her 2-year-old daughter's eyes. She immediately irrigated the girl's eyes with water. The girl had no symptoms. The poison center instructed the mother to take her to an emergency department or urgent care clinic if any new symptoms developed. On 24-hour follow-up, the girl was doing well and had never developed any symptoms.
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What is carbamide peroxide?
Carbamide peroxide is a combination of hydrogen peroxide and urea. Carbamide peroxide releases hydrogen peroxide when it comes into contact with water or surfaces such as the ear or a tooth. Hydrogen peroxide is an antiseptic and bleaching agent.
What is carbamide peroxide used for?
Carbamide peroxide is commonly used for ear wax removal (such as Debrox; at 6.5%), as an oral rinse (10%), and in teeth-whitening products (16–44%). Teeth-whitening kits are both sold for home use and used in dental offices. Home users should follow product directions closely to avoid irritating tissue.
Is carbamide peroxide toxic if ingested?
Swallowing small amounts of low-concentration (up to 14%) carbamide peroxide can cause an upset stomach, vomiting, or throat irritation. However, more serious symptoms would not be expected.
Swallowing a large amount of a low-concentration or small amount of a higher concentration product (greater than 15%) can result in burns to the mouth, esophagus, or stomach or an air embolism. An air embolism occurs when bubbles of air, specifically oxygen in the case of carbamide peroxide, are introduced to the circulatory system and block blood flow. This can cause a stroke or a heart attack. Symptoms of an air embolism include difficulty breathing, chest pain, and confusion. Air emboli are rare but life-threatening. They require immediate emergency medical attention and consultation by a medical toxicologist.
What should I do if I swallow carbamide peroxide or get it in my eyes?
If you swallow carbamide peroxide, drink a glass of water. If it gets in your eye, remove contacts and flush the eye with water for 15–20 minutes. If you are experiencing severe symptoms, such as difficulty breathing, you should seek immediate medical attention.
Get expert help
If you swallow carbamide peroxide, get carbamide peroxide in the eyes, or if you have a question about using carbamide peroxide safely, use the webPOISONCONTROL® online tool to get help, or call your poison center at 1-800-222-1222. Whether online or by phone, expert guidance is always free, confidential, and available 24 hours a day.
Is carbamide peroxide harmful to the eyes?
If carbamide peroxide contacts the eyes, it will cause stinging, burning, and redness. Swelling and blurry vision are also possible. Poison centers often receive calls from people who have mistaken ear wax remover for eye drops and accidentally put it in their eyes. If this happens, immediately rinse with plenty of running water for 15–20 minutes. Fortunately, symptoms usually resolve quickly if the eyes are flushed thoroughly with water.
Carbamide peroxide dosing
The dose for ear wax removal is 5–10 drops in the affected ear canal twice a day for up to 4 days. Follow the directions on the package regarding position of the head, keeping drops in the ear for several minutes, and removing any remaining wax.
When used as an oral rinse for canker sore or minor gum inflammation, swish it around in your mouth for at least 1 minute and then spit it out. It can also be applied directly on the canker sore.
For teeth whitening, first brush and floss, apply gel to the tray, insert trays over your teeth for about 30–60 minutes, remove trays, rinse your mouth, and wait 30 minutes before brushing your teeth again. Follow product directions for cleaning and storing trays.
Side effects of carbamide peroxide
When used in the ear, carbamide peroxide can cause dizziness if the solution is not first warmed to body temperature. When used as an oral rinse or teeth whitener, tooth sensitivity, gum irritation, and redness might occur. Throat irritation can occur if carbamide peroxide is accidentally swallowed. Rarely, allergic reactions (itching, swelling, and rash) can occur.
Prolonged oral use can result in superinfections, as well as loss of minerals from tooth enamel, which can lead to tooth erosion or fracture. Anyone who chooses to use a home teeth-whitening kit should first consult a dentist.