Acetic acid

Acetic acid: Drug information
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(For additional information see “Acetic acid: Patient drug information”)

Brand Names: U.S. VoSoL®
Pharmacologic Category Otic Agent, Anti-infective, Topical Skin Product
Dosing: Adult
Irrigation (Note: Dosage of an irrigating solution depends on the capacity or surface area of the structure being irrigated):

For continuous irrigation of the urinary bladder with 0.25% acetic acid irrigation, the rate of administration will approximate the rate of urine flow; usually 500-1500 mL/24 hours

For periodic irrigation of an indwelling urinary catheter to maintain patency, about 50 mL of 0.25% acetic acid irrigation is required

Otitis externa: Otic: Insert saturated wick; keep moist 24 hours; remove wick and instill 5 drops 3-4 times/day

Dosing: Pediatric Otitis externa: Otic: Children ≥3 years: Insert saturated wick; keep moist 24 hours; remove wick and instill 5 drops 3-4 times/day. Note: 3-4 drops may be sufficient in children due to the smaller capacity of the ear canal.
Dosing: Geriatric Refer to adult dosing.
Dosage Forms: U.S. Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, for irrigation: 0.25% (1000 mL)

Solution, for irrigation [preservative free]: 0.25% (250 mL, 500 mL, 1000 mL)

Solution, otic [drops]: 2% (15 mL, 60 mL)

VoSoL®: 2% (15 mL) [contains benzethonium chloride]

Generic Equivalent Available: U.S. Yes
Administration Not for internal intake or I.V. infusion; topical use or irrigation use only.
Use Irrigation of the bladder; periodic irrigation of indwelling catheters; treatment of superficial bacterial infections of the external auditory canal
Medication Safety Issues
Sound-alike/look-alike issues:
Acetic acid for irrigation may be confused with glacial acetic acid

VoSol® may be confused with Vexol®,VoSol® HC

Adverse Reactions Significant Frequency not defined.
Irrigation solution:

Endocrine & Metabolic: Systemic acidosis

Genitourinary: Urologic pain

Local: Irritation

Renal: Hematuria

Otic solution: Otic: Irritation, burning, stinging

Contraindications Hypersensitivity to acetic acid or any component of the formulation; during transurethral procedures (irrigation); perforated tympanic membrane (otic solution)
Warnings/Precautions
Concerns related to adverse effects:

• Bladder irritation: Use of irrigation in patients with mucosal lesions of urinary bladder may cause irritation. Open lesions of the bladder mucosa may result in systemic acidosis from absorption.

Other warnings/precautions:

• Administration: Not for internal intake or I.V. infusion; topical use or irrigation use only.

Drug Interactions
(For additional information: Launch Lexi-Interact™ Drug Interactions Program )
BCG: Antibiotics may diminish the therapeutic effect of BCG. Risk X: Avoid combination

Pregnancy Risk Factor C (show table)
International Brand Names Aquaear (AU); Earcalm (GB, IE); Suym Otico (PE); Vosol (NZ)
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REFERENCES
Kawamata M, Fujita S, and Mayumi T, “Acetic Acid Intoxication by Rectal Administration,” J Toxicol Clin Toxicol, 1994, 32(3):333-6. [PubMed 8007044]
Penner GE, “Acid Ingestion: Toxicology and Treatment,” Ann Emerg Med, 1980, 9(7):374-9. [PubMed 7396252]