Debrox Dosing for Cerumen Removal
For adults and children over 12 years: instill 5-10 drops into the affected ear twice daily for up to 4 days, keeping the head tilted or placing cotton in the ear for several minutes after application. 1
Specific Dosing Instructions
Adults and Children ≥12 Years
- Tilt head sideways with affected ear facing upward 1
- Instill 5-10 drops into the ear canal 1
- Keep drops in ear for several minutes by maintaining head position or placing cotton in the ear 1
- Use twice daily for up to 4 days 1
- The applicator tip should not enter the ear canal 1
Children Under 12 Years
- Consult a doctor before use 1
- The FDA labeling does not provide specific pediatric dosing for this age group 1
Application Technique for Optimal Effectiveness
Have someone else administer the drops when possible, as only 40% of patients self-medicating do so appropriately 2, 3
Step-by-Step Administration
- Position with the affected ear facing upward 2, 3
- Instill enough drops to fill the ear canal completely 3
- Stay in position for 3-5 minutes to allow adequate penetration 2, 3
- Use gentle to-and-fro movement of the ear or tragal pumping (pressing in/out on the tragus) to help drops penetrate 2, 3
Post-Treatment Wax Removal
Any wax remaining after the 4-day treatment may be removed by gently flushing the ear with warm water using a soft rubber bulb ear syringe 1
- Water should be at close to body temperature to avoid caloric effects and vertigo 4, 2
- Direct irrigation stream along the wall of the ear canal, not directly at the tympanic membrane 2
Evidence Context and Comparative Efficacy
While Debrox (carbamide peroxide) is classified as a non-water, non-oil-based cerumenolytic 4, the evidence shows no specific cerumenolytic agent is superior to another, and none are superior to saline or water alone 4. A Cochrane review found no high-quality evidence to conclude whether one type of cerumenolytic is more effective than another 5. However, any cerumenolytic agent is superior to no treatment, with one study showing 22% complete clearance with active treatment versus 5% with no treatment after 5 days 5.
Important Safety Precautions
Contraindications
- Avoid use in patients with active ear canal infections (otitis externa) 4
- Do not use with perforated tympanic membrane 4
- Avoid in patients with active dermatitis of the ear canal 4
- Do not use if allergic to any component 4
Potential Adverse Effects
Cerumenolytic agents can cause 4:
- Discomfort and skin irritation
- Transient hearing loss
- Dizziness
- Local allergic reactions (lowest risk with non-organic solutions like saline) 4
When to Seek Professional Help
If the ear canal is obstructed by debris, professional aural toilet (cleaning) is needed before drops can be effective 2. This can be performed using 2:
- Gentle lavage with body-temperature water, saline, or hydrogen peroxide
- Suction or dry mop technique (blotting with cotton-tipped applicator)
Do not attempt to clean the ear yourself with cotton swabs, as this can push wax deeper or damage the ear canal 2.