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potassium iodide (Pima Syrup, SSKI, iosat, ThyroSafe, ThyroShield)

 

Classes: Expectorants; Antidotes, Other; Antithyroid Agents

Dosing and uses of Pima Syrup, SSKI (potassium iodide)

 

Adult dosage forms and strengths

tablet

  • 65mg
  • 130mg

oral solution

  • 65mg/mL
  • 325mg/5mL

oral solution (concentrated)

  • 1g/mL

 

Radiation Emergency

Indicted during environmental radiation emergency to block uptake of radioactive iodine isotopes in thyroid and reduce risk of thyroid cancer

130 mg PO qDay; not to exceed 1 dose/24 hr

Ideally initiate 1-48 hr prior to exposure

Continue daily dose until exposure risk has passed and/or until other measures (eg, evacuation, sheltering, control of the food and milk supply) have been successfully implemented

Risk reduction with acute exposure

  • KI initiated shortly before or immediately after acute exposure: 90-99% risk reduction
  • KI initiated within 3-4 hr after acute exposure: 50% risk reduction
  • KI initiated up to 12 hr after acute exposure: limited benefit may be achieved

 

Expectorant

SSKI: 300-600 mg PO q6-8hr

 

Thyrotoxic Crisis

250-500 mg (5-10 gtt of 1 g/mL) PO q4-6hr

 

Preoperative Thyroidectomy

50-250 mg (1-5 gtt of 1 g/mL) PO q8hr for 10-14 days

 

Other Indications & Uses

Cystic fibrosis, chronic sinusitis (adjunct)

 

Pediatric dosage forms and strengths

tablet

  • 65mg
  • 130mg

oral solution

  • 65mg/mL
  • 325mg/5mL

oral solution

  • 1g/mL

 

Radiation Emergency

Indicted during environmental radiation emergency to block uptake of radioactive iodine isotopes in thyroid and reduce risk of thyroid cancer

Infants <1 month: 16.25 mg PO qDay; not to exceed 1 dose/24 hr

1 month-3 years: 32.5 mg PO qDay; not to exceed 1 dose/24 hr

3-13 years: 65 mg PO qDay; not to exceed 1 dose/24 hr

>13 years or adolescents weighing >70 kg (154 lb): 130 mg PO qDay; not to exceed 1 dose/24 hr

Ideally initiate 1-48 hr prior to exposure

Continue daily dose until exposure risk has passed and/or until other measures (eg, evacuation, sheltering, control of the food and milk supply) have been successfully implemented

Risk reduction with acute exposure

  • KI initiated shortly before or immediately after acute exposure: 90-99% risk reduction
  • KI initiated within 3-4 hr after acute exposure: 50% risk reduction
  • KI initiated up to 12 hr after acute exposure: limited benefit may be achieved

 

Neonatal Graves Disease

SSKI: 1 gtt PO q8hr

 

Expectorant

SSKI: 60-250 mg PO q6hr

 

Pima Syrup, SSKI (potassium iodide) adverse (side) effects

Frequency not defined

Arrhythmia

Skin rash

Gastrointestinal irritation or bleeding

Diarrhea

Paresthesia

Swelling or neck or throat

Goiter

Hypothyroidism

Hyperthyroidism

Myxedema

Thyroid adenoma

Allergic reactions (fever, rash)

Lymph node swelling

Salivary gland swelling/tenderness

 

Warnings

Contraindications

Iodine sensitivity (although allergy to radiocontrast media, contact dermatitis from iodine-containing antibacterials, allergy to seafood should NOT be considered evidence of potassium iodide allergy)

Hyperthyroidism

Respiratory failure

 

Cautions

Avoid repeat dosing in neonates or women who are pregnant or breastfeeding if possible; in acute radiation exposure, prioritize these individuals for evacuation; although these precautions should be taken, the benefits of short-term use of KI to block uptake of radioactive iodine by the thyroid gland far exceed its chances of side effects

Prescribe for radiation exposure only upon order from authorities

Caution in tuberculosis

Iodine poisoining (Iodism): Metallic taste, sore mouth, severe headache

 

Pregnancy and lactation

Pregnancy category: d

Increased risk of thyroid suppression in the fetus and neonate leads to a specific recommendation that newborns and pregnant women be given priority with regard to evacuation, safe shelter, and safe food/milk during radiation emergency in order to obviate, as possible, the need for repeat dosing with KI

Lactation: Excreted in breast milk

 

Pregnancy categories

A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA: Information not available.

 

Pharmacology of Pima Syrup, SSKI (potassium iodide)

Mechanism of action

Expectorant: Iodine helps to increase respiratory secretions and decrease viscosity

Hyperthyroidism: Suppresses thyroid hormone synthesis

Thyroid protective: Systemically circulating potassium iodide is readily taken up by thyroid gland by sodium/iodide transporter in basal membrane; concentration gradient of thyroid gland to plasma is 20-50:1

 

Pharmacokinetics

Distribution: Significant extracellular distribution, with most accumulation in thyroid gland

Onset: Therapeutic effects in hyperthyroidism observed within 24 hr

Maximum effect: After 10-15 days of therapy

Duration of effect: Therapeutic effect may persist up to 6 weeks after chronic administration; 24 hr for radioactive iodine exposure

Metabolism: Unknown

Excretion: RenaL