Povidone-iodine (Betadine): Safe use of a common antiseptic
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The bottom line
Povidone-iodine (best known by the brand name Betadine) is an antiseptic commonly used to disinfect the skin, eyes, and, after some medical procedures, vagina. When used correctly, povidone-iodine might cause limited local irritation side effects. When used incorrectly, it can cause severe skin reactions and systemic iodine toxicity.
Prevention tips
Keep all medications in child-resistant containers and stored away from children and pets.
Always keep povidone-iodine in its original container.
Before using any povidone-iodine product, read the Drug Facts section of the medication label carefully and be sure to understand and follow its instructions.
Use as little povidone-iodine as possible and never more than the amount specified on the label.
This really happened
Case 1. A 61-year-old woman called her poison center after she meant to take a dose of cough medicine but unintentionally took a gulp of a 10% povidone-iodine solution instead. She soon developed throat irritation and vomited once. When the poison center called back 7 hours later, her tongue was irritated and a little swollen, but she was otherwise feeling better. A day later, all her symptoms had resolved.
Case 2. A nursing home called their poison center because a 71-year-old woman grabbed a cup that contained Betadine and drank about half a teaspoonful (2.5 mL), thinking it was coffee. Immediately afterward, she vomited a few times. When the poison center followed up 3 hours later, her symptoms had resolved.
Case 3. An emergency department physician called their poison center regarding a 38-year-old man who had swallowed a tablespoonful of Betadine 10% solution, mistaking it for medication. He vomited a few times at home. In the emergency department, his main complaints were throat irritation and nausea. He was given anti-nausea medication and crackers and was watched in the emergency department. The poison center followed up with him at home the next day, and all his symptoms had resolved.
What is povidone-iodine?
Iodine has been used as an antiseptic for centuries. It is effective against bacteria, viruses, and fungi. It is also used to disinfect drinking water. It can be irritating to humans even at antiseptic doses. A common solution to preserve potency while limiting toxicity is to combine iodine with a substance that slows its release. These combinations are called iodophors.
A commonly used iodophor is povidone-iodine. The most well-known povidone-iodine product is Betadine (10% povidone-iodine releasing 1% iodine). Povidone is also used in artificial tears, hair spray, lipstick, gels, and shampoos.
Uses of povidone-iodine
Povidone-iodine’s most common use is as a skin disinfectant. It can disinfect small wounds and treat mild skin infections. It is used to sterilize skin before surgery. It is used in lower concentrations before eye surgery or to treat eye infections (5% povidone-iodine), for presurgical cleansing of the vagina (1% povidone-iodine), or as a gargle for sore throat (0.5% povidone-iodine).
Side effects of povidone-iodine
When used as directed for antiseptic purposes, povidone-iodine is generally safe. Side effects arise when topical povidone-iodine is used chronically and in large amounts. Common side effects seen with both povidone-iodine eye drops and skin formulations include local swelling, irritation, itching, and rash. Numerous cases of contact dermatitis (an allergic-hypersensitivity reaction) from povidone-iodine have been reported in the medical literature.
With overuse, povidone-iodine can have corrosive effects, due to its iodine content. Patients should irrigate their eyes for 15 minutes immediately after an exposure to the eye from povidone-iodine products not intended for use in the eyes. Persistent eye pain or symptoms might require medical evaluation and treatment.
What happens if you swallow povidone-iodine (Betadine)?
Ingestion of povidone-iodine can cause stomach upset, thyroid problems, and burns to the stomach and intestines. In severe cases, heart and kidney failure can occur. These poisonous effects that can occur are largely due to iodine toxicity and often require specialized treatment in a hospital.
Povidone-iodine and COVID-19
Nasal and oral decontamination with povidone-iodine has been recommended for health care workers as a preventive measure against COVID-19 infection. The effectiveness of these treatments remains unclear. Nasal irrigation with saline is a better and safer way to reduce the COVID-19 virus count in the nose.
Concerned about a povidone-iodine exposure?
If you have a question about poisoning from povidone-iodine, 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.
References
Haynes A, Wax PM. Antiseptics, disinfectants, and sterilants. In: Nelson LS, Howland MA, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS, eds. Goldfrank’s Toxicologic Emergencies. 11th ed. McGraw Hill Education; 2019.