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Medical Disclaimer: This information is for educational purposes only and is not a substitute for professional medical advice.
Brand Name
Wax Out Plus
Generic Name
Carbamide Peroxide Drops
Active Ingredient
Carbamide PeroxideCategory
Other
Variants
1
Different strengths and dosage forms
| Strength | Form | Route | NDC |
|---|---|---|---|
| 65 mg/mL | SOLUTION/ DROPS | AURICULAR (OTIC) | 13709-313 |
Detailed information about Wax Out Plus
This page is for informational purposes only and does not replace medical advice. Before using any prescription or over-the-counter medication for Wax Out Plus, you must consult a qualified healthcare professional.
Carbamide Peroxide is a cerumenolytic and oral debriding agent used to soften earwax and cleanse minor oral wounds. It works by releasing oxygen to mechanically break down debris.
For the removal of earwax, the standard adult dosage involves instilling 5 to 10 drops of a 6.5% Carbamide Peroxide solution into the affected ear(s). This procedure should typically be performed twice daily for up to four consecutive days, or as directed by a physician. For oral debriding, a 10% solution or gel is applied to the affected area of the mouth, allowed to remain for at least one minute, and then expectorated (spit out). This can be repeated up to four times daily.
Carbamide Peroxide is generally approved for use in children aged 12 years and older at the same dosage as adults. For children under the age of 12, safety and efficacy have not been firmly established for OTC use. Parents must consult a pediatrician or otolaryngologist before using these drops in younger children, as their ear canals are smaller and more prone to irritation or complications from moisture retention.
Because Carbamide Peroxide is not systemically absorbed, no dosage adjustments are necessary for patients with renal (kidney) impairment. The medication does not enter the bloodstream in quantities that would require filtration by the kidneys.
Similar to renal impairment, hepatic (liver) function does not affect the use of Carbamide Peroxide. There is no systemic metabolism involving the liver, making it safe for patients with liver disease when used topically.
Elderly patients often experience drier, more impacted earwax due to changes in the cerumen-producing glands. While no specific dose adjustment is needed, elderly patients may require a full four-day course and more thorough irrigation to achieve results. Care should be taken if the patient has a history of ear surgery or uses hearing aids.
If a dose is missed, apply it as soon as you remember. However, if it is almost time for the next scheduled application, skip the missed dose and resume your regular schedule. Do not double the number of drops to make up for a missed application.
Systemic overdose is highly unlikely with topical use. However, if the solution is swallowed in large quantities, it may cause gastrointestinal irritation, nausea, vomiting, and bloating due to the release of oxygen in the stomach. In case of accidental ingestion, contact a Poison Control Center immediately. If excessive drops are placed in the ear, simply tilt the head to allow the excess liquid to drain out.
> Important: Follow your healthcare provider's dosing instructions. Do not adjust your dose or use the product for longer than four days without medical guidance.
Most individuals tolerate Carbamide Peroxide well, but some local reactions are common due to the chemical's oxidative nature.
> Warning: Stop using Carbamide Peroxide and call your doctor immediately if you experience any of these symptoms, as they may indicate a more serious underlying condition or an adverse reaction.
Carbamide Peroxide is not intended for long-term or chronic use. Prolonged use (beyond 4-7 days) can lead to:
No FDA black box warnings have been issued for Carbamide Peroxide. It is generally considered a low-risk medication when used according to the labeled instructions for minor ear and mouth issues.
Report any unusual symptoms or persistent irritation to your healthcare provider to ensure there is no underlying infection or structural damage to the ear.
Carbamide Peroxide is for external (otic) or local (oral) use only. It must never be injected, used in the eyes, or swallowed. Patients should be aware that while the product is effective for softening wax, it does not replace the need for professional medical evaluation if symptoms like ear pain or hearing loss persist. It is critical to ensure the eardrum is intact before using this medication in the ear, as the introduction of peroxide into the middle ear can cause severe pain and potential permanent damage.
There are currently no FDA black box warnings for Carbamide Peroxide. It is classified as an OTC drug with a high safety profile when used as directed.
Because Carbamide Peroxide is an OTC medication with no systemic absorption, routine laboratory monitoring (such as blood counts or liver function tests) is not required. However, patients should monitor for:
Carbamide Peroxide may cause temporary dizziness if the drops are cold or if the bubbling action affects the inner ear balance. It may also cause temporary muffled hearing. It is recommended to wait until these sensations pass (usually 5-10 minutes) before driving or operating heavy machinery.
There are no known direct interactions between alcohol consumption and the topical use of Carbamide Peroxide. However, alcohol can sometimes cause vasodilation, which might slightly increase the sensation of warmth or irritation in the ear or mouth if used concurrently.
There is no risk of withdrawal or a need for tapering with Carbamide Peroxide. You may stop using the product as soon as the earwax has cleared or the oral wound has healed. If you experience an adverse reaction, discontinue use immediately and consult a professional.
> Important: Discuss all your medical conditions, especially any history of ear problems or surgeries, with your healthcare provider before starting Carbamide Peroxide.
While systemic drug interactions are non-existent, certain topical combinations must be avoided:
There are no known food interactions with the otic use of Carbamide Peroxide. For oral use, it is advised to avoid eating or drinking for 30 minutes post-application. Specifically, acidic foods (like citrus) or spicy foods may increase the stinging sensation if the oral mucosa is already irritated by the peroxide treatment.
There are no documented interactions between systemic herbal supplements (such as St. John's Wort or Ginkgo Biloba) and topical Carbamide Peroxide. The lack of systemic absorption prevents these substances from interacting in the bloodstream or liver.
Carbamide Peroxide does not typically interfere with standard blood or urine laboratory tests. However, if used orally just before a dental swab or a saliva-based diagnostic test, the oxidative properties could potentially interfere with the enzymatic reactions used in the test (e.g., glucose oxidase tests). Always inform the technician if you have recently used an oral peroxide rinse.
To manage potential interactions:
> Important: Tell your doctor about ALL medications, supplements, and herbal products you are taking, even those applied topically.
Carbamide Peroxide must NEVER be used in the following circumstances:
Conditions requiring a careful risk-benefit analysis by a physician include:
Individuals who have had allergic reactions to hydrogen peroxide (often found in hair dyes or wound cleaners) or urea-based skin creams should exercise extreme caution, as they are likely to react to Carbamide Peroxide. If you have experienced a rash or severe itching with these substances, consult your doctor before using Carbamide Peroxide.
> Important: Your healthcare provider will evaluate your complete medical history, including any past ear injuries, before recommending Carbamide Peroxide.
Carbamide Peroxide is generally considered safe for use during pregnancy. Because the medication is applied topically to the ear or mouth and has negligible systemic absorption, it does not reach the developing fetus in any measurable quantity. The FDA has not assigned a formal pregnancy category to many OTC otic products, but clinical consensus suggests that the risk of teratogenicity (birth defects) is non-existent. However, pregnant women should always consult their obstetrician before starting any new medication, including OTC drops.
It is highly unlikely that Carbamide Peroxide is excreted into human breast milk, as it does not enter the mother's bloodstream in significant amounts. There are no known risks to the nursing infant from the mother's use of ear drops or oral rinses containing this ingredient. Standard hygiene should be practiced to ensure the infant does not come into direct contact with the medication from the mother's hands or ears.
As noted, Carbamide Peroxide is approved for OTC use in children aged 12 and older. In pediatric patients, earwax impaction can sometimes lead to behavioral changes or perceived hearing loss in school. However, because children are more prone to middle ear infections (Otitis Media), it is vital to ensure that the child's symptoms are actually caused by wax and not an infection before using drops. For children under 12, a physician must perform an otoscopic exam (looking into the ear with a light) before any cerumenolytic is used.
Geriatric patients are the primary users of Carbamide Peroxide. As people age, the cerumen becomes harder and less oily, making it more likely to become impacted. While safe, elderly patients should be monitored for balance issues; if the drops cause temporary vertigo, it could increase the risk of falls. Additionally, those who wear hearing aids must be diligent about cleaning the ear canal thoroughly after use to prevent the medication from damaging their devices.
There are no restrictions or dose adjustments for patients with kidney disease. The localized action and lack of systemic absorption mean the kidneys are not involved in the processing or elimination of this drug.
There are no restrictions or dose adjustments for patients with liver disease. The drug does not undergo systemic hepatic metabolism.
> Important: Special populations, particularly the elderly and young children, require individualized medical assessment to ensure the ear canal is healthy before treatment.
Carbamide Peroxide is a pro-drug of hydrogen peroxide. Its primary molecular mechanism involves the release of nascent oxygen. When applied to the ear or mouth, the enzyme catalase (present in tissues and some bacteria) and the aqueous environment trigger the dissociation of the carbamide-peroxide bond. This releases urea and hydrogen peroxide. The hydrogen peroxide then undergoes a rapid decomposition reaction: 2H2O2 → 2H2O + O2.
The resulting oxygen gas creates an effervescent action. In the ear, this mechanical bubbling physically lifts the wax from the canal wall and breaks the wax into smaller, softer fragments. The urea remains as a humectant and keratolytic, further softening the cerumen. In the mouth, the oxygenation helps to mechanically debride (clean) necrotic tissue and organic debris from minor wounds.
The onset of action is immediate upon contact with the target site. The duration of the effervescent effect usually lasts between 1 to 15 minutes, depending on the amount of catalase and moisture present. There is no evidence of systemic pharmacodynamic effects, and tolerance does not develop because the action is purely mechanical and chemical rather than receptor-mediated.
| Parameter | Value |
|---|---|
| Bioavailability | < 1% (Negligible) |
| Protein Binding | N/A |
| Half-life | Seconds to minutes (Local dissociation) |
| Tmax | N/A (Local action) |
| Metabolism | Localized dissociation into Urea and H2O2 |
| Excretion | Not systemically excreted; washed away |
Carbamide Peroxide is classified as an Otic Cerumenolytic and an Oral Debriding Agent. It is chemically related to hydrogen peroxide but is preferred in clinical settings for its stability and slower, more controlled release of oxygen, which reduces the risk of tissue "flash burns" sometimes associated with high-concentration liquid hydrogen peroxide.
Common questions about Wax Out Plus
Carbamide Peroxide is primarily used as a safe and effective way to remove impacted earwax (cerumen) and to cleanse minor wounds or inflammation inside the mouth. In the ear, it works by releasing oxygen to soften and break up hardened wax, making it easier to flush out. For oral use, it helps remove debris, phlegm, and mucus from canker sores or dental irritations. It is also the active ingredient in many professional and over-the-counter teeth whitening products due to its ability to oxidize stains. Always ensure your eardrum is intact before using it in your ear.
The most common side effect is a bubbling or crackling sensation in the ear, which is actually a sign that the medication is working. Some users may also experience a temporary feeling of fullness or muffled hearing as the wax absorbs the liquid and swells slightly. Minor stinging or redness at the application site can also occur. These effects are generally short-lived and resolve once the ear is flushed or the mouth is rinsed. If you experience severe pain or sudden hearing loss, you should stop use and contact a doctor immediately.
Yes, there are no known direct interactions between alcohol and the topical use of Carbamide Peroxide. Since the medication is applied only to the ear canal or the mouth and is not absorbed into the bloodstream, alcohol does not interfere with its mechanism of action. However, if you are using it for oral sores, alcohol can act as an irritant and may increase the stinging sensation or delay the healing of the wound. It is best to avoid alcohol-based mouthwashes while using this product for oral care. Always consult your doctor if you have concerns about mixing medications.
Carbamide Peroxide is considered low-risk and generally safe for use during pregnancy. Because it is used topically and has negligible systemic absorption, it does not enter the mother's circulation in amounts that could affect the developing fetus. There is no evidence suggesting that it causes birth defects or other pregnancy complications. Despite this high safety profile, it is always recommended that pregnant individuals consult with their healthcare provider before using any new medication, including over-the-counter ear drops. This ensures that the symptoms being treated are not signs of a more complex condition.
The chemical action of Carbamide Peroxide begins immediately upon contact with the earwax or mouth sore, as evidenced by the bubbling sensation. However, for effective earwax removal, it usually requires twice-daily applications for up to four consecutive days to fully soften the impaction. After the four-day treatment period, the ear is typically flushed with warm water to remove the loosened debris. If the ear still feels blocked after four days, you should see a healthcare professional for manual removal. Oral sores typically show improvement within a few days of regular use.
Yes, you can stop using Carbamide Peroxide at any time without the risk of withdrawal or rebound effects. It is not a systemic medication, so there is no need to taper the dose. Most people stop using it once their earwax has been successfully cleared or their mouth sore has healed. If you stop the treatment before the earwax is fully softened, the blockage may remain, and you may need to restart the process or seek professional help. If you experience an allergic reaction, you should stop use immediately.
If you miss a dose of Carbamide Peroxide, simply apply the drops as soon as you remember. If it is nearly time for your next scheduled dose, skip the missed one and continue with your regular morning and evening routine. Do not add extra drops to the ear to compensate for a missed application, as this will not speed up the process and may cause unnecessary irritation. Consistency is key to softening the wax, so try to maintain the twice-daily schedule for the full four days. If you miss several days, you may need to restart the four-day cycle.
No, Carbamide Peroxide does not cause weight gain. Weight gain is typically a systemic side effect of medications that affect metabolism, hormones, or appetite, such as steroids or certain antidepressants. Because Carbamide Peroxide is applied topically to the ear or mouth and is not absorbed into the body's systemic circulation, it has no impact on your weight or metabolic processes. Any changes in weight while using this product would be unrelated to the medication itself. If you have concerns about unexplained weight changes, you should discuss them with your primary care physician.
Carbamide Peroxide can generally be used by people taking systemic oral medications because it does not enter the bloodstream. However, you should avoid using it at the same time as other ear drops or topical mouth treatments unless directed by a doctor. Using other ear drops simultaneously can interfere with the bubbling action of the peroxide or cause the other medication to be washed out. If you are prescribed an ear antibiotic, your doctor will usually recommend clearing the wax with Carbamide Peroxide first before starting the antibiotic course. Always inform your healthcare provider of all products you use.
Yes, Carbamide Peroxide is widely available as a generic product and is often sold under various store brands at pharmacies and grocery stores. It is the active ingredient in well-known brand-name products like Debrox and Murine Ear Wax Removal. The generic versions contain the same 6.5% concentration for otic use and are clinically equivalent in efficacy and safety to the brand-name versions. When purchasing a generic, ensure the label specifies Carbamide Peroxide as the active ingredient and follow the included instructions for use. Generic versions are typically more cost-effective for patients.
Other drugs with the same active ingredient (Carbamide Peroxide)