compounding expert pharmacists working in lab compounding medicine at Harbor Compounding Pharmacy

Drug Monograph

Boric Acid Vaginal Capsules

DESCRIPTION

Boric acid (BA) is a white powder or crystalline solid that acts as a strong antiviral and antifungal agent in the body.

HOW SUPPLIED

Boric Acid is available as a 600mg gelatin capsule for vaginal use.

CLINICAL PHARMACOLOGY

Information regarding the mechanism of action of boric acid in mediating its antibacterial or antifungal actions is limited. Boric acid inhibits biofilm formation and hyphal transformation of Candida albicans, which are critical virulence factors6. In addition, arrest of fungal growth was observed with the treatment of boric acid6.

PHARMACOKINETICS

Orally administered BA is readily and completely absorbed. After absorption, BA appears to be rapidly distributed throughout the body water via passive diffusion. Following administration of BA, the ratio of blood: soft tissue concentrations of boron (B) is approximately 1.0; in contrast, concentrations of B in bone exceed those in blood by a factor of approximately 4.0. In rats, adipose tissue concentrations of B are only 20% of the levels found in blood and soft tissues; however, human data on adipose tissue levels are not available. BA does not appear to be metabolized in humans owing to the excessive energy required to break the B-O bond. BA has an affinity for cis-hydroxy groups, and it has been hypothesized to elicit its biological activity through this mechanism.

CLINICAL RESEARCH
Candida

The BASIC study1 indicates that boric acid is effective in treating Candida infections, including cases that do not resolve with common antifungal medications. People with recurrent yeast infections may benefit most from boric acid treatment.

Keller and colleagues3 reported a cure rate for boric acid 600mg of 92% at 7-10 days of treatment for vulvovaginal candidiasis albicans versus a 64% cure rate for nystatin 100,000U.

Authors of a 2011 medical review report2 that boric acid is a safe and economical option for people with recurrent or chronic vaginal infections, especially when conventional treatment is ineffective.

Torulopsisglabrata. alabrata

One study suggests clinical improvement in seven of nine female patients with mixed infection of T. alabrata vaginitis and BV after atreatment with BA 600 mg intravaginal for 14 nights.4

Torulopsisglabrata glabratavaginitis

Boric Acid 600mg vaginally X 14 days revealed clinical improvement or cures in treatment of T. glabratavaginitis = 21 of 26 episodes (81%).4

Bacterial Vaginosis (BV)

When Boric Acid was added to nitroimidazole there was promising long-term (>88 % cure rate at 12 weeks after the study and 50 % at 36 weeks of follow-up) suppression of recurrent BV.5

EXCRETION

BA is eliminated unchanged in the urine. The kinetics of elimination were evaluated in human volunteers given BA orally or intravenously; the half-life for elimination was essentially the same (approx. 21 h) by either route of exposure

INDICATION AND USAGE
Treatment of vaginal infection

According to the Centers for Disease Control and Prevention (CDC), people should use boric acid as a secondary treatment, that is, if other antifungal drugs or ointments are unable to treat the yeast infection or if it recurs.

Boric acid may be able to treat infections that are resistant to first-line treatment. This is usually an antifungal medication, which may involve a single oral dose of fluconazole or a topical antifungal cream. If these do not work, a doctor may recommend using boric acid or another treatment, such as nystatin or flucytosine.

Boric acid has also been shown to help rebalance vaginal pH and restore normal health, relieve internal and external vaginal burning, itching, and irritation, and reduce foul odor due to vaginal infection.

Boric acid should not be used if abdominal pain, fever, or foul-smelling vaginal discharge is present. Vaginal intercourse should be avoided during treatment.

Boric acid capsules should be used vaginally, and is possibly unsafe for adults and children when taken by mouth at high doses.

DOSAGE AND ADMINISTRATION

A person can use a gelatin capsule as a vaginal suppository. The CDC recommend using capsules that each contain 600 mg of boric acid once a day for 2 weeks.

According to RxList, Boric acid is likely safe when used vaginally for up to six months.

For prevention or recurring Candida infections: 60-mg twice weekly.

DRUG INTERACTIONS

Boron seems to affect the way the body handles other minerals such as magnesium and phosphorus. It also seems to increase estrogen levels in older (post-menopausal) women and healthy men.

ADVERSE REACTIONS
Genitourinary

Frequency not reported: Watery discharge, erythema, slight burning or gritty sensation with intercourse

Pregnancy

There is no data on use in pregnant women to know this drugs risks, including the risk of fetal harm or reproductive effects.

Animal studies are not available. There are no controlled data in human pregnancy.

Nursing Mothers

Use is contraindicated.
Excreted into human milk: Data not available
Excreted into animal milk: Data not available

There is no information regarding this drug on the presence in human milk, the effects on a breastfed infant, or effects on milk production.

PRECAUTIONS
  • Fever
  • Nausea
  • Vaginal Bleeding
  • STD
  • Heart Disease
  • Blood Vessel disorder
  • Hormone sensitive conditions such as breast cancer, uterine cancer, ovarian cancer, endometriosis, or uterine fibroids.
  • Kidney disease or problems with kidney function
CONTRAINDICATIONS
  • Pregnancy
  • Nursing mothers
STORAGE

Room temperature

REFERENCES
  1. Zeron Mullins M, Trouton KM. BASIC study: is intravaginal boric acid non-inferior to metronidazole in symptomatic bacterial vaginosis? Study protocol for a randomized controlled trial. Trials. 2015;16:315.
  2. Iavazzo C, Gkegkes ID, Zarkada IM, Falagas ME. Boric acid for recurrent vulvovaginal candidiasis: the clinical evidence. J Womens Health. 2011 (8):1245-55.
  3. Keller Van Slyke K, Michel VP, Rein MF. Treatment of vulvovaginal candidiasis with boric acid powder. Am J ObsGyne. 1981;141:145–8
  4. Sobel JD, Chaim W. Treatment of Torulopsisglabrata vaginitis: retrospective review of boric acid therapy. ClinInf Dis. 1997;24:649–52. doi: 10.1093/clind/24.4.649.
  5. Reichman O, Akins R, Sobel JD. Boric acid addition to suppressive antimicrobial therapy for recurrent bacterial vaginosis. Sex Transm Dis. 2009;36(11):732–4.
  6. De Seta F, Schmidt M, Vu B, Essmann M, Larsen B: Antifungal mechanisms supporting boric acid therapy of Candida vaginitis. J Antimicrob Chemother. 2009 Feb;63(2):325-36. doi: 10.1093/jac/dkn486. Epub 2008 Dec 4
MEDICAL DISCLAIMER

This drug monograph does not provide medical or legal advice. All content found on this drug monograph, including: text, images, audio, or other formats were created for informational purposes only. Viewing this drug monograph, receipt of information contained in this monograph, or the transmission of this information from our pharmacy does not constitute a pharmacist-patient relationship.

The medical information on this monograph is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read on this drug monograph.

If you think you may have a medical emergency, call your doctor, go to the emergency department, or call 911 immediately. Harbor Compounding Pharmacy does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on any of our content.

Medical information changes constantly. Therefore the information on our drug monograph(s) should not be considered current, complete or exhaustive, nor should you rely on such information to recommend a course of treatment for you or any other individual. Reliance on any information provided by Harbor Compounding Pharmacy, its employees, contracted writers, or medical professionals presenting content for publication to Harbor Compounding Pharmacy is solely at your own risk.

CONTACT

Harbor Compounding Pharmacy

2000 Harbor Blvd, Suite C100
Costa Mesa, CA 92627