Talk:Iodine (medical use)

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WHO definitions

There is a bit of a inconsistency in how the WHO defines the drug called just "iodine" in the ATC and the essential list.

The essential list puts iodine under the "27. VITAMINS AND MINERALS" section.

• The 2008 list, cited in the model formulary, lists the forms as: "Capsule: 200 mg. Iodized oil: 1 ml (480 mg iodine); 0.5 ml (240 mg iodine) in ampoule (oral or injectable); 0.57 ml (308 mg iodine) in dispenser bottle."
• The 2019 list says: "Capsule: 190 mg. Iodized oil: 1 mL (480 mg iodine); 0.5 mL (240 mg iodine) in ampoule (oral or injectable); 0.57 mL (308 mg iodine) in dispenser bottle."

The article has sources that show the iodized oil is not elemental iodine. However, I can't find anything about the capsule. I would assume that the "vitamin" context suggests that it's probably not elemental, but that's not a source. (In the meantime, "potassium iodide" is listed under "18. Hormones, other endocrine medicines and contraceptives".)

• https://medicalguidelines.msf.org/en/viewport/EssDr/english/iodized-oil-oral-16683900.html suggests that it's a capsule containing the oil. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5952947/ and https://pubmed.ncbi.nlm.nih.gov/12762640/ also confirm that such a capsule exists.
• So as far as the Essential List is concerned, the treatment for iodine deficiency DOES NOT involve ingesting elemental iodine. The EL does include one case of ingesting elemental iodine in the form of Lugol's solution, but the indication is "thyrotoxicosis", i.e. as an alternative to potassium iodide. --Artoria2e5 🌉 08:18, 7 March 2024 (UTC)

The ATC code puts "iodine" under D08AG03, i.e. under "ANTISEPTICS AND DISINFECTANTS". So that probably maps to iodophors and tinctures, unlike what the EL is doing. Artoria2e5 🌉 07:27, 7 March 2024 (UTC)

Okay, now there's a footnote explaining the two WHO concepts. But what is this going to mean for wikidata? Artoria2e5 🌉 07:36, 7 March 2024 (UTC)

Okay, put correct ATC mappings onto Wikidata. Moved boxed warning and Essential List info around per my identified ontology. I cannot change interwiki yet, because we have not yet disentangled this article (and maybe we never will.) Artoria2e5 🌉 07:51, 7 March 2024 (UTC)

Okay, just ran a search for the boxed warnings.

• For povidone-iodine, it's about "for external use" and "flammable". Boring. https://nctr-crs.fda.gov/fdalabel/ui/spl-summaries/criteria/577968 Also, nothing about pregancy.
• For "iodine" (same search query), it's a generic supplement thing about iron. Also boring. Also, nothing about pregancy.
• For "ETHIODIZED OIL", it's more useful:
  • FOR INTRALYMPHATIC, INTRAUTERINE AND SELECTIVE HEPATIC INTRA-ARTERIAL USE ONLY
  • Pulmonary and cerebral embolism can result from inadvertent intravascular injection...
  • It does have a pregnancy thing.

FDA does not have the oral oil thing. Artoria2e5 🌉 07:48, 7 March 2024 (UTC)

Alright, the "flammable" thing is found speficially on a "POVIDONE-IODINE, LIDOCAINE, AND ALCOHOL" combination; really it's the alcohol that burns. There is one "Unapproved drug other" called "Lugols Solution" that lists "Iodine" as the only thing; the box just says "Single Use Only. CAUTION: Restricted to us e by or on the order of a phys cian. Do not use if seal has been broken."

So it's really just a nothingburger for topical iodine. Artoria2e5 🌉 14:16, 7 March 2024 (UTC)

What to do

Let's decide what to do with the article, now that the ontology is somewhat clear.

1. The current lead graf seems to suggest that the same "iodine" is both an antiseptic and a treatment for deficiency, which is not support by WHO sources: it's two different things being united by an unfortunate terminology, each deserving an infobox.
   1. The antiseptic. This is listed as D08AG03 in ATC. There is no exact match in the Essential List: it only has polyvidone iodine (i.e. Povidone-iodine) in chapter 15, D08AG02 in ATC. Either way, both are topical.
   2. The oil. The Essential List calls it "iodine" in chapter 27 and allows oral and IM administration. The ATC code on eEML is H03CA, which maps to "iodine therapy", "iodine preparations for systemic use." The defined daily dose (DDD) for H03CA is 0.33 g, which is... not too unreasonable, if it's only one or two days per year. I dunno.
      • The EML does not mention its use as a radiocontrast, but other sources has established these two are chemically the same. As a radiocontrast, the ATC code is V08AD01. The US FDA name is "ethiodized oil", for use via "intralymphatic, intrauterine and selective hepatic intra-arterial" injection.
2. And we have the many, smaller mentions, from other uses of compounds containing iodine in medicine to iodized salt at the end of the lead section.

I would like to keep the usefulness of (2) as an index while fixing the problem of (1). My head is hurting a little too much to do anything about it. Do we use two infoboxes? Do we split the article into three (1.1 iodine-the-antiseptic, 1.2 iodized oil, 2 index of iodine in medicine)? Surely three is too many, right? --Artoria2e5 🌉 08:18, 7 March 2024 (UTC)

Just split the infoboxes for the article. While looking for the UNII code for concept 1.2, I found that we do have an article for it: Lipiodol.

Maybe I will end up with an article for (concept 1.1 + index 2), and an article for concept 1.2 -- that would only require rewriting the lede to (1) take out the ingestion mentions (2) add a mention of all the many compounds.

Or maybe I will still do three, I don't know. Artoria2e5 🌉 08:40, 7 March 2024 (UTC)