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Silver

Pronunciation

(SIL ver)

Index Terms

  • SilverSeal

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Gel, External:

Arida: (25 g, 45 g, 100 g, 500 g, 1000 g, 5000 g, 25000 g)

Elta SilverGel: (45 mL, 473 mL)

Pad, External:

Silverseal Hydrogel Dressing: 2"X3" (1 ea, 10 ea); 4"X5" (1 ea, 10 ea) [contains methylparaben, propylparaben]

Brand Names: U.S.

  • Arida
  • Elta SilverGel [OTC]
  • Silverseal Hydrogel Dressing

Pharmacologic Category

  • Antibiotic, Topical

Pharmacology

Elemental silver becomes positively charged when exposed to wound exudate. Once ionized, silver is bactericidal; it binds to bacterial cell membranes, disrupts the bacterial cell wall, and causes cell leakage (International Consensus, 2012).

Absorption

Little systemic absorption (International Consensus, 2012)

Excretion

Feces (primarily) and urine (International Consensus, 2012)

Use: Labeled Indications

Wound management: Topical anti-infective used in the management of first- or second-degree burns and wounds (including abrasions; device insertion wounds; lacerations, skin tears, and/or superficial wounds; donor, graft, and/or surgical incision sites; diabetic, pressure, and/or stasis ulcers).

Contraindications

Hypersensitivity to silver or any component of the formulation.

3M Tegaderm Ag Mesh: Hypersensitivity to cotton; application to third-degree burns; use as a surgical sponge; use with enzymatic debriding agents that are contraindicated with silver products

Acticoat, Acticoat Flex 3 and 7, Acticoat Surgical: Use during magnetic resonance imaging (MRI) or radiation therapy

Acticoat Moisture Control: Use during MRI

Acticoat Site: Hypersensitivity to polyurethane; use during MRI

Restore: Hypersensitivity to alginates; application to third-degree burns; surgical implantation; to control heavy bleeding; use on dry or lightly exuding wounds

Silverseal Hydrogel: Hypersensitivity to nylon; use with cardiac defibrillators

Dosing: Adult

Wound Management: Note: General dosing considerations presented; consult full manufacturers labeling prior to use. Assess need for continued treatment after 2 weeks of therapy. Once the infection is under control and the wound is healing, consider a change to a nonantimicrobial dressing (International Consensus, 2012).

Dressing: Topical:

3M Tegaderm Ag Mesh: For dry to minimally draining wounds, moisten dressing with sterile normal saline, sterile water, or liquid hydrogel prior to application to the wound. For moderate to highly draining wounds, premoistening may not be required. May be secured with a cover dressing to manage wound drainage; a moisture-retentive barrier dressing may be used as a cover dressing to help maintain a moist environment.

Acticoat, Acticoat 7: Moisten dressing with sterile water (not saline) and remove excess water prior to application to wound; heavily exudative wounds may not require premoistening of the dressing. Secure with appropriate secondary dressing. Keep dressing humid and change as needed. Acticoat 7 may be left in place for up to 7 days.

Acticoat Flex: Apply directly to wound, keep dressing moist and secure with appropriate secondary dressing. If wound is dry or there is minimal exudate, moisten dressing with drinking water prior to application. Acticoat Flex 3 may be left in place for up to 3 days; Acticoat Flex 7 may be left in place for up to 7 days.

Acticoat Moisture Control, Acticoat Site, Acticoat Surgical: Apply directly to wound. Do not moisten dressing prior to application. Sterile water should be used if wound needs cleaned prior to use. Change dressing as needed; may remain in place for up to 7 days. Acticoat Moisture Control and Acticoat Site may be secured with appropriate secondary dressing.

Restore: Apply directly to wound and cover with a nonocclusive dressing; change as needed.

Silverseal: Apply directly to wound and cover with conventional dressing that will maintain a moist environment. Change within 7 days.

SilvrSTAT: Apply directly to wound and cover with conventional dressing; change every 24 to 72 hours or as needed.

Gel: Topical:

RevitaDERM: Apply 1/8 inch to 1/4 inch thick layer to wound and cover with dressing. Change as needed to keep the wound moist.

SilverMED: Apply ~ 1/4 inch thick layer to wound; may cover with dressing.

Dosing: Geriatric

Refer to adult dosing.

Dosing: Renal Impairment

There are no dosage adjustments provided in the manufacturer’s labeling. However, dosage adjustment unlikely due to low systemic absorption.

Dosing: Hepatic Impairment

There are no dosage adjustments provided in the manufacturer’s labeling. However, dosage adjustment unlikely due to low systemic absorption.

Administration

For external use only.

Dressings should be applied to clean wounds. Refer to manufacturer labeling for recommendations on appropriate secondary dressings. Prior to removal, dressings that have adhered to the wound surface may first be saturated with sterile normal saline or sterile water; gently remove once dressing has softened.

Acticoat (all products): Prior to application, do not use with saline.

Storage

Store at room temperature.

Drug Interactions

There are no known significant interactions.

Adverse Reactions

Frequency not defined.

Dermatologic: Allergic skin reaction, erythema, skin cyanosis, local discoloration (temporary black discoloration at application site)

Local: Application site irritation

Warnings/Precautions

Concurrent drug therapy issues:

• Enzymatic debriding agents: Silver dressings should not be used on wounds undergoing enzymatic debridement (International Consensus, 2012).

Special populations:

• Pediatric: Use with caution (International Consensus, 2012).

Dosage form specific issues:

• 3M Tegaderm Ag Mesh: Remove prior to magnetic resonance imaging (MRI). Effectiveness may be decreased with concomitant use of iodophor-containing products.

• Acticoat, Acticoat Flex 3 and 7: Remove prior to MRI or radiation therapy. Do not use with saline. Dressing is not compatible with oil-based products (eg, petrolatum). Do not use Acticoat if color is not uniform; Acticoat Flex 3 and 7 dressing color may vary and does not affect performance. Avoid contact with electrodes or conductive gels during electronic measurements such as electroencephalogram (EEG) and electrocardiogram (ECG).

• Acticoat 7: Do not use with saline. Dressing is not compatible with oil-based products (eg, petrolatum). Do not use if product color is not uniform. Avoid contact with electrodes or conductive gels during electronic measurements such as EEG and ECG.

• Acticoat Moisture Control, Acticoat Site, Acticoat Surgical: Remove prior to MRI. Do not use with saline. Dressing is not compatible with oil-based products (eg petrolatum), topical antimicrobials, or oxidizing agents. Avoid contact with electrodes or conductive gels during electronic measurements such as EEG and ECG. Acticoat Site and Acticoat Surgical should be removed prior to radiation therapy. Acticoat Site should be removed prior to x-ray (may obscure imaging).

• Restore: Dressing performance may be impaired with excessive use of petrolatum ointments.

• Silverseal: Remove prior to cardiac defibrillation, MRI, or radiation therapy. Dressing is not compatible with oil-based products (eg, petrolatum).

Other warnings/precautions:

• Appropriate use: For external use only. Silver dressings are used to reduce bacteria in acute or chronic wounds and to act as an antimicrobial barrier for acute or chronic wounds that have a high risk of infection or reinfection. The manufacturers labeling should be consulted prior to use. Silver dressings should not be used on clean wounds or small acute wounds at low risk of infection, or chronic wounds that are healing. Use caution on very large wounds. Silver dressings are intended to be used on wounds requiring silver delivery over several days, reducing the need for frequent dressing changes (International Consensus, 2012).

Pregnancy Considerations

Although systemic absorption following topical application is considered to be low, use in pregnancy is not currently recommended (International Consensus, 2012)

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Have patient report immediately to prescriber signs of skin infection (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.

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