Silver

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Gel, External:

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

Collatyl: (42 g)

Elta SilverGel: (45 mL [DSC], 473 mL [DSC])

Protyl Ag: 1% (42 g)

SilvaSorb: (44.4 mL)

Solox: (45 mL) [contains trolamine (triethanolamine)]

Pad, External:

Aceso Ag: 4"X4" (4 ea)

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

Tegaderm Ag Mesh: 2"X2" (1 ea); 4"X5" (1 ea); 4"X8" (1 ea); 8"X8" (1 ea)

Pharmacology

Mechanism of Action

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).

Pharmacokinetics/Pharmacodynamics

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

Dosage and Administration

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: Apply directly to wound; change as needed. Dressing remains effective for up to 7 days.

Acticoat, Acticoat 7: Apply directly to wound; Acticoat 7 may be left in place for up to 7 days.

Acticoat Flex: Apply directly to wound. 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. Change dressing as needed; may remain in place for up to 7 days.

Restore: Apply directly to wound; change as needed.

Silverseal: Apply directly to wound; change within 7 days.

SilvrSTAT: Apply directly to wound; change every 24 to 72 hours or as needed.

Gel: Topical:

RevitaDERM, Solox: Apply ¹/₈ inch to ¹/₄ inch thick layer to wound. Repeat as needed to keep the wound moist.

SilverMed: Apply ~¹/₄ inch thick layer to wound.

Dosing: Geriatric

Refer to adult dosing.

Administration

For external use only.

Dressings should be applied to clean wounds. Refer to manufacturer labeling for recommendations on need for moistening dressing prior to application and selection of 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 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).
• Solox: Do not use on wounds with high amounts of exudate.

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 manufacturer's 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

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.