There is limited information regarding <i>Off-Label Guideline-Supported Use</i> of {{PAGENAME}} in adult patients.
<!--Non–Guideline-Supported Use (Adult)-->
|offLabelAdultNoGuideSupport======Condition1=====
* Dosing Information
:* Dosage
=====Condition2=====
There is limited information regarding <i>Off-Label Non–Guideline-Supported Use</i> of {{PAGENAME}} in adult patients.
<!--Pediatric Indications and Dosage-->
<!--FDA-Labeled Indications and Dosage (Pediatric)-->
|fdaLIADPed======Condition1=====
* Dosing Information
:* Dosage
=====Condition2=====
There is limited information regarding <i>FDA-Labeled Use</i> of {{PAGENAME}} in pediatric patients.
<!--Off-Label Use and Dosage (Pediatric)-->
<!--Guideline-Supported Use (Pediatric)-->
|offLabelPedGuideSupport======Condition1=====
* Developed by:
* Class of Recommendation:
* Strength of Evidence:
* Dosing Information
:* Dosage
=====Condition2=====
There is limited information regarding <i>Off-Label Guideline-Supported Use</i> of {{PAGENAME}} in pediatric patients.
<!--Non–Guideline-Supported Use (Pediatric)-->
|offLabelPedNoGuideSupport======Condition1=====
* Dosing Information
:* Dosage
=====Condition2=====
There is limited information regarding <i>Off-Label Non–Guideline-Supported Use</i> of {{PAGENAME}} in pediatric patients.
<!--Contraindications-->
|contraindications=* Condition1
<!--Warnings-->
|warnings=* Description
====Precautions====
* Description
<!--Adverse Reactions-->
<!--Clinical Trials Experience-->
|clinicalTrials=There is limited information regarding <i>Clinical Trial Experience</i> of {{PAGENAME}} in the drug label.
=====Body as a Whole=====
=====Cardiovascular=====
=====Digestive=====
=====Endocrine=====
=====Hematologic and Lymphatic=====
=====Metabolic and Nutritional=====
=====Musculoskeletal=====
=====Neurologic=====
=====Respiratory=====
=====Skin and Hypersensitivy Reactions=====
=====Special Senses=====
=====Urogenital=====
=====Miscellaneous=====
<!--Postmarketing Experience-->
|postmarketing=There is limited information regarding <i>Postmarketing Experience</i> of {{PAGENAME}} in the drug label.
=====Body as a Whole=====
=====Cardiovascular=====
=====Digestive=====
=====Endocrine=====
=====Hematologic and Lymphatic=====
=====Metabolic and Nutritional=====
=====Musculoskeletal=====
=====Neurologic=====
=====Respiratory=====
=====Skin and Hypersensitivy Reactions=====
=====Special Senses=====
=====Urogenital=====
=====Miscellaneous=====
<!--Drug Interactions-->
|drugInteractions=* Drug
:* Description
<!--Use in Specific Populations-->
|useInPregnancyFDA=* '''Pregnancy Category'''
|useInPregnancyAUS=* '''Australian Drug Evaluation Committee (ADEC) Pregnancy Category'''
There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of {{PAGENAME}} in women who are pregnant.
|useInLaborDelivery=There is no FDA guidance on use of {{PAGENAME}} during labor and delivery.
|useInNursing=There is no FDA guidance on the use of {{PAGENAME}} with respect to nursing mothers.
|useInPed=There is no FDA guidance on the use of {{PAGENAME}} with respect to pediatric patients.
|useInGeri=There is no FDA guidance on the use of {{PAGENAME}} with respect to geriatric patients.
|useInGender=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific gender populations.
|useInRace=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific racial populations.
|useInRenalImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with renal impairment.
|useInHepaticImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with hepatic impairment.
|useInReproPotential=There is no FDA guidance on the use of {{PAGENAME}} in women of reproductive potentials and males.
|useInImmunocomp=There is no FDA guidance one the use of {{PAGENAME}} in patients who are immunocompromised.
<!--Administration and Monitoring-->
|administration=* Oral
* Intravenous
|monitoring=There is limited information regarding <i>Monitoring</i> of {{PAGENAME}} in the drug label.
'''Sodium hypochlorite''' is a [[chemical compound]] with the [[chemical formula|formula]] NaClO. Sodium hypochlorite solution, commonly known as [[bleach]], is frequently used as a [[disinfectant]] and as a bleaching agent.
* Description
==Production==
<!--IV Compatibility-->
Sodium hypochlorite may be prepared by absorbing [[chlorine]] gas in cold [[sodium hydroxide]] solution:
|IVCompat=There is limited information regarding <i>IV Compatibility</i> of {{PAGENAME}} in the drug label.
Sodium hydroxide and chlorine are commercially produced by the [[chloralkali process]], and there is no need to isolate them to prepare sodium hypochlorite. Hence NaClO is prepared industrially by the [[electrolysis]] of [[sodium chloride]] solution with minimal separation between the [[anode]] and the [[cathode]]. The solution must be kept below 40 °C (by cooling coils) to prevent the formation of [[sodium chlorate]].
====Signs and Symptoms====
The commercial solutions always contain significant amounts of sodium chloride (common salt) as the main byproduct, as seen in the equation above.
* Description
==Packaging and sale==
====Management====
Household bleach sold for use in laundering clothes is a 3-6[[percentage solution|% solution]] of sodium hypochlorite at the time of manufacture. Strength varies from one formulation to another and gradually decreases with long storage.
A 12% solution is widely{{fact|date=September 2007}} used in waterworks for the chlorination of water. High-test hypochlorite (HTH) is sold for chlorination of swimming pools and contains approximately 30% calcium hypochlorite. The crystalline salt is also sold for the same use; this salt usually contains less than 50% of calcium hypochlorite. However, the level of "active chlorine" may be much higher.
* Description
It can also be found on store shelves present in "Daily Sanitizing Sprays", as the sole active ingredient at 0.0095%.
===Chronic Overdose===
==Uses==
There is limited information regarding <i>Chronic Overdose</i> of {{PAGENAME}} in the drug label.
In household [[bleach]] form, sodium hypochlorite is used for removal of stains from laundry. It is particularly effective on cotton fiber, which stains easily but bleaches well. 50 to 250 ml per load is usually recommended for a standard-size washer. The properties of household bleach that make it effective for removing stains also result in cumulative damage to organic fibers such as cotton, and the useful lifespan of these materials will be shortened with regular bleaching. The sodium hydroxide (NaOH) that is also found in household bleach (as noted later) causes fiber degradation as well. It is not volatile, and residual amounts of NaOH not rinsed out will continue slowly degrading organic fibers in the presence of humidity. For these reasons, if stains are localized, spot treatments should be considered whenever possible. With safety precautions, post-treatment with weak organic acids such as acetic (vinegar) will neutralize the NaOH, and volatilize the chlorine from residual hypochlorite. Old t-shirts and cotton sheets that rip easily demonstrate the costs of laundering with household bleach. Hot water increases the activity of the bleach, owing to the thermal decomposition of hypochlorite which ultimately generates environmentally-undesirable chlorate.
A weak solution of 1% household bleach in warm water is used to sanitize smooth surfaces prior to brewing of beer or wine. Surfaces must be rinsed to avoid imparting flavors to the brew; these chlorinated byproducts of sanitizing surfaces are also harmful.
<!--Pharmacology-->
US Government regulations (21 CFR Part 178) allow food processing equipment and food contact surfaces to be sanitized with solutions containing bleach provided the solution is allowed to drain adequately before contact with food, and the solutions do not exceed 200 parts per million (ppm) available chlorine (for example, one tablespoon of typical household bleach containing 5.25% sodium hypochlorite, per gallon of water). If higher concentrations are used, the surface must be rinsed with potable water after sanitizing.
<!--Drug box 2-->
|drugBox=<!--Mechanism of Action-->
|mechAction=*
A 1 in 5 dilution of household bleach with water (1 part bleach to 4 parts water) is effective against many [[bacterium|bacteria]] and some [[virus]]es, and is often the disinfectant of choice in cleaning surfaces in hospitals (Primarily in the United States). The solution is [[corrosion|corrosive]], and needs to be thoroughly removed afterwards, so the bleach disinfection is sometimes followed by an [[ethanol]] disinfection.
<!--Structure-->
|structure=*
For [[shock chlorination]] of wells or water systems, a 2% solution of household bleach is used. For larger systems, HTH is more practical because lower rates can be used. The alkalinity of the sodium hypochlorite solution also causes the precipitation of minerals such as calcium carbonate, so that the shock chlorination is often accompanied by a clogging effect. The precipitate also preserves bacteria, making this practice somewhat less effective.
: [[File:{{PAGENAME}}01.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]
Sodium hypochlorite has been used for the disinfection of drinking water, at a concentration equivalent to about 1 liter of household bleach per 4000 liters of water is used. The exact amount required depends on the water chemistry, temperature, contact time, and presence or absence of sediment. In large-scale applications, residual chlorine is measured to titrate the proper dosing rate. For ''emergency'' disinfection, the [[United States Environmental Protection Agency]] [[#External links|recommends]] the use of 2 drops of 5%ac household bleach per quart of water. If the treated water doesn't smell of bleach, 2 more drops are to be added.
<!--Pharmacodynamics-->
|PD=There is limited information regarding <i>Pharmacodynamics</i> of {{PAGENAME}} in the drug label.
The use of chlorine-based disinfectants in domestic water, although widespread, has led to some controversy due to the formation of small quantities of harmful byproducts such as [[chloroform]].
<!--Pharmacokinetics-->
|PK=There is limited information regarding <i>Pharmacokinetics</i> of {{PAGENAME}} in the drug label.
It is also used in [[dentistry]], during root canal treatment, disinfecting the canal and dissolving any remaining pulp tissue. Historically, [[Henry Drysdale Dakin]]'s solution (0.5%) had been used.
<!--Nonclinical Toxicology-->
Nowadays, 2.5-5.25% solutions are being used.
|nonClinToxic=There is limited information regarding <i>Nonclinical Toxicology</i> of {{PAGENAME}} in the drug label.
An alkaline solution (pH 11.0) of sodium hypochlorite is used to treat dilute (< 1 g/L) cyanide wastewater, e.g. rinsewater from an electroplating shop. In batch treatment operations, sodium hypochlorite has been used to treat more concentrated cyanide wastes, such as silver cyanide plating solutions. A well-mixed solution is fully treated when an excess of chlorine is detected.
<!--Clinical Studies-->
|clinicalStudies=There is limited information regarding <i>Clinical Studies</i> of {{PAGENAME}} in the drug label.
==Mechanism of action==
<!--How Supplied-->
[[Hypochlorous acid#Mode of disinfectant action|See Hypochlorous acid]]
|howSupplied=*
==Cautions==
<!--Patient Counseling Information-->
Sodium hypochlorite is a strong [[oxidizer]]. Products of the oxidation reactions are corrosive. Solutions burn skin and cause eye damage, particularly when used in concentrated forms. However, as recognized by the NFPA, only solutions containing more than 40% sodium hypochlorite by weight are considered hazardous oxidizers. Solutions less than 40% are classified as a moderate oxidizing hazard (NFPA 430, 2000).
|fdaPatientInfo=There is limited information regarding <i>Patient Counseling Information</i> of {{PAGENAME}} in the drug label.
Household bleach and pool chlorinator solutions are typically stabilized by a significant concentration of lye (caustic soda, NaOH) as part of the manufacturing reaction. Skin contact will produce caustic irritation or burns due to defatting and saponification of skin oils and destruction of tissue. The slippery feel of bleach on skin is due to this process.
<!--Precautions with Alcohol-->
|alcohol=* Alcohol-{{PAGENAME}} interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.
[[Sodium thiosulfate]] (hypo) is an effective chlorine neutralizer. Rinsing with a 5mg/L solution, followed by washing with soap and water, quickly removes chlorine odor from the hands.
<!--Brand Names-->
|brandNames=* ®<ref>{{Cite web | title = | url = }}</ref>
Chlorination of drinking water can oxidize organic contaminants, producing [[trihalomethane]]s (also called haloforms), which are carcinogenic. The extent of the hazard thus created is a subject of disagreement.
<!--Look-Alike Drug Names-->
|lookAlike=* A® — B®<ref name="www.ismp.org">{{Cite web | last = | first = | title = http://www.ismp.org | url = http://www.ismp.org | publisher = | date = }}</ref>
Mixing bleach with some household cleaners can be hazardous. For example, mixing an [[acid]] cleaner with sodium hypochlorite bleach generates [[chlorine]] gas. Mixing with [[ammonia]] solutions (including [[urine]]) produces [[chloramines]]. Both chlorine gas and chloramine gas are [[toxic]]. Bleach can react violently with [[hydrogen peroxide]] and produce oxygen gas:<ref>{{cite web|url=http://library.advanced.org/3347/h2o2+bleach4.html|title=Hydrogen Peroxide + Bleach Explanation|accessdaymonth=10 April|accessyear=2007}}</ref>
It is estimated that there are about 3300 accidents needing hospital treatment caused by sodium hypochlorite solutions each year in British homes (RoSPA, 2002).
*Institut National de Recherche et de Sécurité. (2004). "Eaux et extraits de Javel. Hypochlorite de sodium en solution". ''Fiche toxicologique n° 157'', Paris.
==External links==
*[http://www.ilo.org/public/english/protection/safework/cis/products/icsc/dtasht/_icsc04/icsc0482.htm International Chemical Safety Card 0482] (solutions<10% active Cl)
*[http://www.ilo.org/public/english/protection/safework/cis/products/icsc/dtasht/_icsc11/icsc1119.htm International Chemical Safety Card 1119] (solutions >10% active Cl)
*[http://ecb.jrc.it/ European Chemicals Bureau]
*[http://www.inrs.fr/ Institut National de Recherche et de Sécurité] (''in French'')
*[http://www.hassandlass.org.uk/query/reports/2002data.pdf Home and Leisure Accident Statistics 2002] (UK RoSPA)
*[http://www.epa.gov/safewater/faq/emerg.html Emergency Disinfection of Drinking Water] ([[United States Environmental Protection Agency]])
*[http://osuextra.okstate.edu/pdfs/FAPC-116web.pdf Guidelines for the Use of Chlorine Bleach as a Sanitizer in Food Processing Operations] (Oklahoma State University)
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Black Box Warning
ConditionName:
See full prescribing information for complete Boxed Warning.
ConditionName:
Content
Overview
Sodium hypochlorite is a {{{drugClass}}} that is FDA approved for the {{{indicationType}}} of {{{indication}}}. There is a Black Box Warning for this drug as shown here. Common adverse reactions include .
Adult Indications and Dosage
FDA-Labeled Indications and Dosage (Adult)
Condition1
Dosing Information
Dosage
Condition2
Dosing Information
Dosage
Condition3
Dosing Information
Dosage
Condition4
Dosing Information
Dosage
Off-Label Use and Dosage (Adult)
Guideline-Supported Use
Condition1
Developed by:
Class of Recommendation:
Strength of Evidence:
Dosing Information
Dosage
Condition2
There is limited information regarding Off-Label Guideline-Supported Use of Sodium hypochlorite in adult patients.
Non–Guideline-Supported Use
Condition1
Dosing Information
Dosage
Condition2
There is limited information regarding Off-Label Non–Guideline-Supported Use of Sodium hypochlorite in adult patients.
Pediatric Indications and Dosage
FDA-Labeled Indications and Dosage (Pediatric)
Condition1
Dosing Information
Dosage
Condition2
There is limited information regarding FDA-Labeled Use of Sodium hypochlorite in pediatric patients.
Off-Label Use and Dosage (Pediatric)
Guideline-Supported Use
Condition1
Developed by:
Class of Recommendation:
Strength of Evidence:
Dosing Information
Dosage
Condition2
There is limited information regarding Off-Label Guideline-Supported Use of Sodium hypochlorite in pediatric patients.
Non–Guideline-Supported Use
Condition1
Dosing Information
Dosage
Condition2
There is limited information regarding Off-Label Non–Guideline-Supported Use of Sodium hypochlorite in pediatric patients.
Contraindications
Condition1
Warnings
ConditionName:
See full prescribing information for complete Boxed Warning.
ConditionName:
Content
Description
Precautions
Description
Adverse Reactions
Clinical Trials Experience
There is limited information regarding Clinical Trial Experience of Sodium hypochlorite in the drug label.
Body as a Whole
Cardiovascular
Digestive
Endocrine
Hematologic and Lymphatic
Metabolic and Nutritional
Musculoskeletal
Neurologic
Respiratory
Skin and Hypersensitivy Reactions
Special Senses
Urogenital
Miscellaneous
Postmarketing Experience
There is limited information regarding Postmarketing Experience of Sodium hypochlorite in the drug label.
