Boric Acid Vaginal Suppositories

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About boric acid

Boric was first marketed in 1939, and had many general uses, such as treating symptoms associated with vaginitis. It wasn’t until recently, in January 2016, when a commercially available homeopathic boric acid vaginal suppository (Hylafem Homeopathic RX Vaginal Suppository)came to the market. Although there are commercially available homeopathic products available, the FDA hasn’t evaluated these products for safety or efficacy. It’s unknown how boric acid actually works, but what we do know is that boric acid is effective topically against preventing the growth of bacteria and fungi.

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Boric acid and Bacterial Vaginosis

Studies show that boric acid may increase the pH of the vagina (making it more acidic), and this leads to the prevention of fungal growth. In addition, boric acid has been shown to exert slow-acting bacteriostatic activity against staphylococci and streptococci. Current guidelines recommend treating bacterial vaginosis with prescription only oral medications called nitroimidazoles. In addition to that, the CDC suggests that adding boric acid vaginal suppositories to the treatment regimen may be effective for women with recurrent bacterial vaginosis. 

Important things to know before using boric acid

Do not ingest boric acid. Severe boric acid poisoning and fatalities have occurred. Boric acid is made for topical use only. There is still a risk of developing systemic toxicity even when applied topically. Infants and children are at the highest risk. Do not apply to skin that is cut or broken.

Signs and symptoms of acute toxicity following excessive absorption of boric acid may include: nausea and vomiting; diarrhea; abdominal pain; hemorrhagic gastroenteritis; CNS stimulation (weakness, lethargy, headache, and restlessness, tremor, twitching of facial muscles and extremities, and seizures) followed by CNS depression; metabolic acidosis; intravascular coagulation; and fever. Severe and fatal poisoning with boric acid may manifest as oliguria, anuria, renal tubular necrosis, hepatomegaly, jaundice, cyanosis, shock, circulatory collapse, and death. If accidentally swallowed or if systemic toxicity is suspected, seek medical help or contact a poison control center immediately.

Do not use if pregnant or breast feeding. Boric acid should never be administered to neonates or infants. Do not use boric acid vaginal products in children 12 years or younger. Keep all boric acid products out of the reach of children.

Boric acid vaginal suppositories are not recommended for use by patients with high blood pressure, cardiac disease or blood vessel disease. Vaginal use is not recommended in patients with immunosuppression, including patients with acquired immunodeficiency syndrome (AIDS); use is considered contraindicated by the manufacturer.[ Patients with known sexually transmitted disease (STD) or a history of pelvic inflammatory disease (PID) should only receive the vaginal boric acid products under the close supervision and prescription of a health care provider. Patients should discontinue use and seek medical examination and advice for any vaginal bleeding, sores, ulcerations, nausea, fever or chills, sensitivity in your lower pelvis or abdomen, or suspected sexually transmitted disease (STD) or pelvic inflammatory disease Open genital or vaginal wounds can increase the risk for systemic absorption of boric acid and toxicity. 

What side effects can I expect using boric acid vaginally?

When used short term and as directed, boric acid vaginal products generally won’t cause significant side effects. You can expect to have watery or gritty vaginal discharge, irritation of the vagina, redness, and slight burning. In addition, if you’re allergic to boric acid, some reactions you may experience include anaphylactic reactions, dyspnea or difficulty breathing, chest pain (unspecified), angioedema, pruritus, urticaria or other rash (unspecified), pruritus, and skin irritation or inflammation. If these occur, discontinue use immediately. 

How to use Boric acid vaginal suppositories

Wash hands thoroughly with soap and water.

  • Take out the capsule suppository from the foil pouch (if applicable) and insert the capsule suppository into the open end of the applicator.
  • Gently insert the applicator with the vaginal capsule suppository into the patient’s vagina as far as possible, following the directions of the product.
  • Depress the plunger so that the capsule suppository is released.
  • Withdraw the applicator and discard the disposable applicator.
  • Wash hands after insertion.
  • Patient may wish to wear a panty liner after product is inserted as directed
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Other instructions

Avoid sexual intercourse during the treatment period.

Do not douche

Keep the area around your vagina and rectum clean (wash the area daily with warm water).

Wipe yourself from front to back after using the toilet

Use only as recommended by a physician or as directed on the product package

 If you have a female sexual partner, tell her that you have a vaginal infection. She should see her health care provider and be treated if she has symptoms.

If you have a male sexual partner, he does not need treatment.

Wipe yourself from front to back after using the toilet.

Keep all follow-up visits as told by your health care provider. This is important

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Hope this helps !

Dr. Adrianna Shardey, PharmD

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