Names and pronunciation
SSKI, Lugol’s
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Drug reference
SSKI, Lugol’s
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Func. class.: Thyroid hormone antagonist, antidote
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Chem. class.: Iodine product
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ACTION: Inhibits secretion of thyroid hormone, fosters colloid accumulation in thyroid follicles, decreases vascularity of gland
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USES: Preparation for thyroidectomy, thyrotoxic crisis, neonatal thyrotoxicosis, radiation protectant, thyroid storm
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Unlabeled uses: Sporotrichosis, thyroid P involution induction, thyrotoxicosis, Grave’s disease
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CONTRAINDICATIONS: Preg nancy, pulmonary edema, pulmonary TB, bronchitis, hypersensitivity to iodine Precautions: Breastfeeding, children
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SIDE EFFECTS CNS: Headache, confusion, paresthesias CV: Tachycardia, cardiac arrest, dysrrthmias EENT: Metallic taste, stomatitis, saliva- tion, periorbital edema, sore teeth and gums, cold symptoms ENDO: Hypothyroidism, hyperthyroid adenoma, hyperkalemia GI: Nausea, diarrhea, vomiting, small- bowel lesions, upper gastric pain, metal- lic taste INTEG: Rash, urticaria, angioneurotic edema, acne, mucosal hemorrhage, fever MS: Myalgia, arthralgia, weakness
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INTERACTIONS Increase: hypothyroidism—lithium, other antithyroid agents Increase: hyperkalemia—angiotensin II receptor antagonist, ACE inhibitors, potassium salts, potassium-sparing diuretics
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DOSAGE AND ROUTES Hyperthyroidism/thyrotoxicosis • Adult/child: PO (SSKI) 250 mg tid × 10-14 days preoperatively Preparation for thyroidectomy • Adult/child: PO 3-5 drops strong io- dine sol tid or 1-5 drops SSKI in water tid after meals for 10 days before surgery Radiation exposure (radioactive iodine) • Adult: PO 130 mg/day (distribution by government/public health officials or OTC purchase) • Child ≥3 yr: PO 65 mg daily • Child/infant >1 mo-3 yr: PO 32 mg/day • Neonate: PO 16 mg/day
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Available forms: Oral sol (Lugol’s solution) iodine 5%/potassium iodide 10%; oral sol (SSKI) 1 g/mL 65 mg/mL
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Administer: • Products are not interchangeable • Strong iodine solution after diluting with water or juice to improve taste • Through straw to prevent tooth discol- oration • With meals to decrease GI upset • At same time each day to maintain product level • At lowest dose that relieves symptoms; discontinue before RAIU
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Assess: • Pulse, B/P, temperature; serum potas- sium • I&O ratio; check for edema: puffy hands, feet, periorbit; indicate hypothy- roidism • Weight daily; same clothing, scale, time of day • T3, T4, which is increased; serum TSH, which is decreased; free thyroxine index, which is increased if dosage is too low; discontinue product 3-4 wk before RAIU • Overdose: peripheral edema, heat intolerance, diaphoresis, palpitations, dysrhythmias, severe tachycardia, fever, delirium, CNS irritability • Hypersensitivity: rash; enlarged cer- vical lymph nodes may indicate product should be discontinued • Hypoprothrombinemia: bleeding, pete- chiae, ecchymosis • Clinical response: after 3 wk should include increased weight, pulse; de- creased T4 • Fluids to 3-4 L/day unless contraindi- cated • Pregnancy/breastfeeding: do not use in pregnancy, breastfeeding
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Evaluate: • Therapeutic response: weight gain; de- creased pulse, T4, size of thyroid gland
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To abstain from breastfeeding after delivery • To keep graph of weight, pulse, mood • To avoid OTC products that contain iodine • That seafood, other iodine products may be restricted • Not to discontinue product abruptly; that thyroid crisis may occur as part of stress response • That response may take several mo if thyroid is large • To discontinue product, notify pre- scriber of fever, rash, metallic taste, swell- ing of throat; burning of mouth, throat; sore gums, teeth; severe GI distress, en- largement of thyroid, cold symptoms
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PHARMACOKINETICS PO: Onset 24-48 hr, peak 10-15 days after continuous therapy, uptake by thy- roid gland or excreted in urine, crosses placenta
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• Adult/child: PO (SSKI) 250 mg tid × 10-14 days preoperatively Preparation for thyroidectomy
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• Adult/child: PO 3-5 drops strong io- dine sol tid or 1-5 drops SSKI in water tid after meals for 10 days before surgery Radiation exposure (radioactive iodine)
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• Adult: PO 130 mg/day (distribution by government/public health officials or OTC purchase)
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