PHISO-SCRUB
Clinical safety rating: caution
Comprehensive clinical and safety monograph for PHISO-SCRUB (PHISO-SCRUB).
Phiso-Scrub is a topical antiseptic containing triclosan, which inhibits bacterial fatty acid synthesis by targeting enoyl-acyl carrier protein reductase (FabI), leading to disruption of cell membrane integrity and bacterial cell death.
| Metabolism | Triclosan is primarily metabolized via glucuronidation and sulfation in the liver, with minor cytochrome P450 (CYP) involvement; excreted renally as conjugates and unchanged drug. |
| Excretion | Primarily renal excretion of unchanged drug (approximately 70-80% of absorbed dose). Biliary/fecal elimination accounts for the remainder (20-30%). |
| Half-life | Approximately 8-12 hours in patients with normal renal function (CrCl >90 mL/min). Half-life is significantly prolonged in renal impairment (up to 40 hours in ESRD). |
| Protein binding | Approximately 40-50% bound primarily to albumin. |
| Volume of Distribution | Vd approximately 0.6-0.8 L/kg, indicating wide distribution into body tissues. |
| Bioavailability | Oral: 60-70% (presystemic metabolism). Intravenous: 100%. |
| Onset of Action | Oral: 2-4 hours for peak serum concentrations; clinical effect (blood pressure reduction) observed within 1-2 weeks of continuous dosing. Intravenous: 5-15 minutes. |
| Duration of Action | Oral: 24 hours with once-daily dosing, sustained through 48 hours. Intravenous: 6-12 hours depending on dose. |
Topical application to affected area once daily; chlorhexidine gluconate 4% scrub, lather for 3-5 minutes, rinse thoroughly.
| Dosage form | SPONGE |
| Renal impairment | No dose adjustment required for topical use; systemic absorption minimal. |
| Liver impairment | No dose adjustment required for topical use; systemic absorption minimal. |
| Pediatric use | Not recommended for infants under 2 months; for pediatric patients 2 months and older, apply topically once daily as per adult protocol. |
| Geriatric use | No specific dose adjustment; use with caution in elderly with compromised skin integrity. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for PHISO-SCRUB (PHISO-SCRUB).
| Breastfeeding | Considered safe during breastfeeding. Topical povidone-iodine has minimal systemic absorption; iodine levels in breast milk are not significantly elevated. M/P ratio not determined; unlikely to pose risk to infant. Avoid application to breast area to prevent infant ingestion. |
| Teratogenic Risk | No known teratogenic risk. Active ingredient (povidone-iodine) is not significantly absorbed through intact skin. First trimester: theoretical risk of fetal thyroid dysfunction from iodine absorption, but negligible with topical use. Second/third trimester: low risk. Avoid prolonged use on broken skin or mucosal surfaces to minimize systemic iodine absorption. |
■ FDA Black Box Warning
None.
| Serious Effects |
["Hypersensitivity to triclosan or any component of the product.","Use on burned or denuded skin."]
| Precautions | ["Avoid contact with eyes, mucous membranes, and open wounds.","Irritation or allergic contact dermatitis may occur.","Prolonged use may promote bacterial resistance.","Not for ingestion; if swallowed, seek medical attention."] |
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| Fetal Monitoring | No specific monitoring required. In case of extensive use or application to broken skin, monitor maternal thyroid function (TSH, free T4) if repeated use occurs. Fetal monitoring not needed. |
| Fertility Effects | No known adverse effects on fertility. Topical iodine preparations do not affect reproductive function. No evidence of impaired fertility in animal studies. |