Ammoniated Mercury (Topical)


VA CLASSIFICATION
Primary: DE101
{08}
Note: For a listing of dosage forms and brand names by country availability, see Dosage Forms section(s).

Not commercially available in Canada.



Category:


Antibacterial—

Indications

Unaccepted
Ammoniated mercury has been used for the topical treatment of impetigo contagiosa, dermatomycoses, superficial pyodermas, seborrheic dermatitis, psoriasis, and pediculosis pubis; however, it has been replaced by more effective and safer agents {01} {09} {21} {27} {28} {29} {32}.


Pharmacology/Pharmacokinetics

Physicochemical characteristics:
Molecular weight—
    252.07

Mechanism of action/Effect:

Ammoniated mercury has a bacteriostatic action that is probably the result of inhibition of bacterial sulfhydryl enzymes {17} {21} {31}.

Absorption:

Ammoniated mercury is systemically absorbed {18} {20} {30}.


Precautions to Consider

Pregnancy/Reproduction

Pregnancy—
Studies have not been done in humans. However, ammoniated mercury is systemically absorbed {18} {20} {30}.

Studies have not been done in animals.

Breast-feeding

Although ammoniated mercury is {30} systemically absorbed, it is not known whether it is distributed into breast milk. However, problems in humans have not been documented {18} {20}.

Pediatrics

Use is not recommended in children, since ammoniated mercury may cause acrodynia. {09} {16} {19} {32}


Geriatrics


No information is available on the relationship of age to the effects of ammoniated mercury in geriatric patients.

Drug interactions and/or related problems
The following drug interactions and/or related problems have been selected on the basis of their potential clinical significance (possible mechanism in parentheses where appropriate)—not necessarily inclusive (» = major clinical significance):


Note: Combinations containing any of the following medications, depending on the amount present, may also interact with this medication.

Iodine-containing preparations, topical    (concurrent use with ammoniated mercury may increase the possibility of toxicity {01})


Sulfur-containing preparations    (concurrent use with ammoniated mercury may result in a chemical reaction releasing hydrogen sulfide, which has a foul odor, may be irritating, and may stain the skin black {01})


Medical considerations/Contraindications
The medical considerations/contraindications included have been selected on the basis of their potential clinical significance (reasons given in parentheses where appropriate)— not necessarily inclusive (» = major clinical significance).


Except under special circumstances, this medication should not be used when the following medical problems exist:
» Burns, serious or{01}
» Wounds, deep or open{01}{32}    (use may cause mercury poisoning)


Risk-benefit should be considered when the following medical problem exists
Sensitivity to ammoniated mercury    (use may cause allergic contact dermatitis {01} {20} {21} {30} {32})




Side/Adverse Effects
The following side/adverse effects have been selected on the basis of their potential clinical significance (possible signs and symptoms in parentheses where appropriate)—not necessarily inclusive:

Those indicating need for medical attention
    
Hypersensitivity {01}{20}{22}(irritation not present before therapy)
    
skin infection {01}




Overdose
For more information on the management of overdose or unintentional ingestion, contact a Poison Control Center (see Poison Control Center Listing ).

Clinical effects of overdose {20} {21}
The following effects have been selected on the basis of their potential clinical significance (possible signs and symptoms in parentheses where appropriate)—not necessarily inclusive:
    
Cloudy urine
    
dizziness
    
headache, continuing or severe
    
irritation, soreness, or swelling of gums
    
nausea
    
skin rash or unusual redness of skin


Treatment of overdose
Patients in whom intentional overdose is known or suspected should be referred for psychiatric consultation.


Patient Consultation
As an aid to patient consultation, refer to Advice for the Patient, Ammoniated Mercury (Topical).

In providing consultation, consider emphasizing the following selected information (» = major clinical significance):

Before using this medication
»   Conditions affecting use, especially:
Sensitivity to ammoniated mercury





Use in children—Not recommended, since medication may cause acrodynia

Other medical problems, especially deep or open wounds or serious burns

Proper use of this medication
» Importance of not using more medication than the amount recommended

» Not using medication on deep or open wounds or serious burns

» Avoiding contact with the eyes

Proper administration: Applying enough to cover affected area; rubbing in gently

» Proper dosing
Missed dose: Applying as soon as possible; not applying if almost time for next dose

» Proper storage

Precautions while using this medication
» Avoiding concurrent use with topical iodine-containing or sulfur-containing preparations


Side/adverse effects
Signs of potential side effects, especially hypersensitivity, skin infection, and symptoms of mercury poisoning


General Dosing Information
Application of ammoniated mercury to large areas, or frequent or prolonged use, may cause mercury poisoning {01}.


Topical Dosage Forms

AMMONIATED MERCURY OINTMENT USP

Usual adult and adolescent dose
Antibacterial
Topical, to the skin, one or two times a day {01}.


Usual pediatric dose
Use is not recommended in children, since it may cause acrodynia. {09} {16} {19}

Usual geriatric dose
See Usual adult and adolescent dose.

Strength(s) usually available
U.S.—


5% (OTC)[Generic]{01}{09}

Canada—
Not commercially available.

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a well-closed, light-resistant container. Protect from freezing.

Auxiliary labeling:
   • Poison.
   • For external use only.



Revised: 07/29/1994



References
  1. Ammoniated Mercury package insert (Lilly—US), Rev 4/83, Rec 1/89.
  1. Not used.
  1. Not used.
  1. Not used.
  1. Not used.
  1. Not used.
  1. Not used.
  1. Fleeger CA, editor. USAN 1988. USAN and the USP dictionary of drug names. Rockville, MD: The United States Pharmacopeial Convention, Inc., 1987: 329.
  1. Olin BR, editor. Drug facts and comparisons. St. Louis: Facts and Comparisons Inc, 1987.
  1. Not used.
  1. Not used.
  1. Not used.
  1. Not used.
  1. Not used.
  1. Not used.
  1. Reviewer comment, 1/87.
  1. Gilman AG, Rall TW, Nies AS, Taylor P, editors. Goodman and Gilman's the pharmacological basis of therapeutics. 6th ed. New York: Pergamon Press, 1980: 975.
  1. Reviewer comment, 10/82.
  1. Panel comment, 1978.
  1. U.S. Pharmacist 1985: 20.
  1. Federal Register 1982; 47(2): 436-42.
  1. Reviewer comment, 7/89.
  1. Not used.
  1. Not used.
  1. Not used.
  1. Not used.
  1. Aberer W. Topical mercury should be banned—dangerous, outmoded, but still popular. J Am Ac Derm 1991 Jan; 24(1): 150-1.
  1. Federal Register 1991 July; 56(140): 33673.
  1. Aberer W, et al. Ammoniated mercury ointment-Outdated but still in use. Contact Dermatitis 1990; 23(3): 168.
  1. Reviewer comment, 3/91.
  1. Katzung BG, editor. Basic and clinical pharmacology. Norwalk: Appleton and Lange, 1992: 692.
  1. Reynolds JEF, editor. Martindale, the extra pharmacopeia. 28th ed. London: The Pharmaceutical Press, 1982: 762-3.
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