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Irrigation, transurethral: Note: Dosage of an irrigating solution depends on the capacity or surface area of the structure being irrigated Urinary bladder, continuous or intermittent irrigation: Transurethral: 0.25% irrigation solution: Usual volume: 500-1500 mL per 24 hours; the rate of administration will approximate the rate of urine flow Indwelling urinary catheter, periodic irrigation to maintain patency: Transurethral: 0.25% irrigation solution: ~50 mL is required for each irrigation

Otitis externa: Otic: Insert saturated wick of cotton; keep moist 24 hours by adding 3-5 drops every 4-6 hours; remove wick after 24 hours and instill 5 drops 3-4 times daily 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) Generic Equivalent Available: U.S. Yes Administration Not for internal intake or I.V. infusion; topical use or irrigation use only Bladder irrigation: Urine pH should be checked at least 4 times daily and the irrigation rate adjusted to maintain a pH of 4.5-5; increasing the rate decreases the pH and vice versa Stability Irrigation solution: Store at 20°C to 25°C (68°F to 77°F); do not exceed 66°C (150°F); do not freeze. Discard the unused portion as it does not contain preservatives. Otic solution: Store at 20°C to 25°C (68°F to 77°F). Use Otic solution: Treatment of superficial infections of the external auditory canal (FDA approved in ages ≥3 years and adults) Irrigation solution: Irrigation of the bladder; periodic irrigation of indwelling catheters (FDA approved in adults) 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

Otic solution: Otic: Irritation, burning, stinging Contraindications Hypersensitivity to acetic acid or any component Irrigation: Use during transurethral procedures Otic solution: Perforated tympanic membrane Warnings Irrigation solution is not for internal intake or I.V. infusion; irrigation use only. Use of bladder 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. Discontinue use if pain or hematuria occur during irrigation. Otic solution is for external, topical use only; transient stinging and burning may occur with the initial use in an acutely inflamed ear; discontinue promptly if sensitization or irritation occur. Metabolism/Transport Effects None known. Drug Interactions (For additional information: Launch Lexi-Interact™ Drug Interactions Program ) BCG: Antibiotics may diminish the therapeutic effect of BCG. Risk X: Avoid combination Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Risk D: Consider therapy modification Pregnancy Risk Factor C ( show table ) Pregnancy Implications Animal reproduction studies have not been conducted. Systemic absorption following bladder irrigation is not likely unless open lesions are present. Use of UpToDate is subject to the Subscription and License Agreement . Topic 87235 Version 2.0 © 2013 UpToDate, Inc. All rights reserved. | Subscription and License Agreement | Release: 21.4 - C21.36 Licensed to: Southeast Alabama Med Ctr | Support Tag: [0504-61.234.146.186-40244E071D-S244013.14]