hydrogen peroxide (Rx)

Brand and Other Names:Eskata
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

solution, topical

  • 40%

Seborrheic Keratosis

Indicated for raised seborrheic keratosis (SK) in adults

During a single in-office treatment session, apply topical solution to seborrheic keratosis lesions 4 times, ~1 minute apart

After one use, discard the unit dose applicator

If treated lesions have not completely cleared ~3 weeks after treatment, another treatment may be administered following the same procedure

See Administration

Seborrheic keratosis is not seen in the pediatric population

Safety and efficacy not established

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Adverse Effects

>10%

10 minutes after application

  • Erythema (98%)
  • Stinging (93%)
  • Edema (85%)
  • Pruritus (32%)
  • Vesiculation (18%)

1 week after application

  • Scaling (72%)
  • Erythema (66%)
  • Crusting (67%)
  • Pruritus (18%)

15 weeks after application

  • Erythema (21%)
  • Hyperpigmentation (18%)
  • Scaling (16%)
  • Crusting (12%)

1-10%

1 week after application

  • Erosion (9%)
  • Ulceration (4%)

15 weeks after application

  • Hypopigmentation (7%)

<1%

Eyelid edema

Herpes zoster

Postmarketing Reports

Crepitus

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Warnings

Contraindications

None

Cautions

Eye disorders

  • Avoid eye exposure
  • Eye disorders, including corneal injury (erosion, ulceration, perforation, and scarring), chemical conjunctivitis, eyelid edema, severe eye pain, or permanent eye injury, including blindness, can occur after exposure
  • If accidental exposure occurs, flush eyes with water for 15-30 minutes and initiate monitoring and further evaluation as appropriate

Local skin reactions

  • Severe reactions, including ulcerations and scarring, may occur
  • Do not retreat until the skin has recovered from any reaction caused by the previous treatment
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Pregnancy

Pregnancy

Hydrogen peroxide is not absorbed systemically following topical administration, and maternal use is not expected to result in fetal exposure to the drug

Lactation

Hydrogen peroxide is not absorbed systemically by the mother following topical administration, and breastfeeding is not expected to result in exposure of the child to hydrogen peroxide

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.

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Pharmacology

Mechanism of Action

Exact mechanism unknown; the 40% topical solution is designed to penetrate into the SK lesion and causing oxidative damage, which can ultimately result in the sloughing of the SK cells

Absorption

Hydrogen peroxide rapidly dissociates into water and reactive oxygen species

Indirect assessment of reactive oxygen species in patients with SK lesions did not demonstrate any systemic absorption of hydrogen peroxide

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Administration

Topical Preparation

Prepare lesions

  • Clean SKs to be treated using an alcohol wipe
  • When treating SKs on the face, take appropriate actions to ensure that solution will not come into contact with the eyes

Prepare applicator

  • Wear nitrile or vinyl examination gloves during activation of the applicator and during administration of the solution to the lesion(s)
  • While activating the applicator, hold it away from the patient
  • See illustrated instructions in prescribing information

Topical Administration

High-concentration solution (40%) designed for in-office topical application by healthcare provider

Provides targeted treatment applied directly to raised SK using a penlike applicator

For topical use only; not for oral, ophthalmic, or intravaginal use

Do not apply to mucous membranes

Do not apply to open or infected SKs

Application

  • Following release of the solution from the ampule, remove the cap from applicator
  • Gently squeeze applicator barrel to express a drop of solution and ensure wetting of the applicator tip
  • Apply solution directly to the seborrheic keratosis in a circular motion
  • Apply enough solution to uniformly wet the lesion surface, including the edges, but without excess running or dripping
  • During the application, remove any excess solution from the surrounding skin using a clean absorbent wipe (do not use paper towels or tissue)
  • Apply again in the same manner, 3 additional applications 1 minute apart

Storage

Store at 20-25°C (68-77°F), excursions permitted between 15-30°C (59-86° F)

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Images

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Formulary

FormularyPatient Discounts

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  • View the formulary and any restrictions for each plan.
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The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

Tier Description
1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
NC NOT COVERED – Drugs that are not covered by the plan.
Code Definition
PA Prior Authorization
Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
QL Quantity Limits
Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
ST Step Therapy
Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
OR Other Restrictions
Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.