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Minor inflammation of gums, oral mucosal surfaces, and lips: Topical: Oral solution (should not be used for >7 days): Apply several drops undiluted on affected area 4 times/day after meals and at bedtime; expectorate after 2-3 minutes or place 10 drops onto tongue, mix with saliva, swish for several minutes, expectorate

Ear wax removal: Otic: Tilt head sideways and instill 5-10 drops twice daily up to 4 days, tip of applicator should not enter ear canal; keep drops in ear for several minutes by keeping head tilted and placing cotton in ear Dosing: Pediatric (For additional information see "Carbamide peroxide: Pediatric drug information" ) Relief of minor inflammation of gums, oral mucosal surfaces, and lips: Topical: Children ≥2 years: Refer to adult dosing.

Ear wax removal: Otic: Children <12 years: Tilt head sideways and individualize the dose according to patient size; 3 drops (range: 1-5 drops) twice daily for up to 4 days, tip of applicator should not enter ear canal. Keep drops in ear for several minutes by keeping head tilted and placing cotton in ear. Children ≥12 years: Refer to adult dosing. Dosing: Geriatric Refer to adult dosing. Dosage Forms: U.S. Excipient information presented when available (limited, particularly for generics); consult specific product labeling. Liquid, oral: 10% (60 mL) Cankaid®: 10% (15 mL) Gly-Oxide®: 10% (15 mL, 60 mL) Solution, otic [drops]: 6.5% (15 mL) Auraphene B®: 6.5% (15 mL) Auro®: 6.5% (22.2 mL) Debrox®: 6.5% (15 mL, 30 mL) E-R-O®: 6.5% (15 mL) [ethanol free] Murine® Ear: 6.5% (15 mL) [contains ethanol 6.3%] Murine® Ear Wax Removal Kit: 6.5% (15 mL) [contains ethanol 6.3%] Otix®: 6.5% (15 mL) Wax Away: 6.5% (15 mL) Generic Equivalent Available: U.S. Yes Use Relief of minor inflammation of gums, oral mucosal surfaces, and lips including canker sores and dental irritation; emulsify and disperse ear wax Adverse Reactions Significant Frequency not defined. Dermatologic: Rash Local: Irritation, redness Miscellaneous: Superinfection Contraindications Hypersensitivity to carbamide peroxide or any component of the formulation; otic preparation should not be used in patients with a perforated tympanic membrane; ear drainage, ear pain, or rash in the ear Warnings/Precautions

Dosage form specific issues: • Oral: With prolonged use of oral carbamide peroxide, there is a potential for overgrowth of opportunistic organisms, damage to periodontal tissues, and delayed wound healing; should not be used for longer than 7 days. Not for OTC use in children <2 years of age. • Otic: Do not use if ear drainage or discharge, ear pain, irritation, or rash in ear. Should not be used for longer than 4 days. Not for OTC use in children <12 years of age. Metabolism/Transport Effects None known. Drug Interactions (For additional information: Launch Lexi-Interact™ Drug Interactions Program ) There are no known significant interactions. Pricing: U.S. (Medi-Span®)

Solution (Murine Ear Wax Removal System Otic) 6.5% (15 mL): $5.23 International Brand Names Blanc-Dient (AR); Earclear (NZ) Mechanism of Action Carbamide peroxide releases hydrogen peroxide which serves as a source of nascent oxygen upon contact with catalase; deodorant action is probably due to inhibition of odor-causing bacteria; softens impacted cerumen due to its foaming action Pharmacodynamics/Kinetics Onset of action: ~24 hours Use of UpToDate is subject to the Subscription and License Agreement . Topic 8841 Version 32.0 © 2013 UpToDate, Inc. All rights reserved. | Subscription and License Agreement | Release: 21.3 - C21.34 Licensed to: Morehouse School of Medicine | Support Tag: [1104-118.195.65.244-820E8C5BBF-S473950.14]