Silver sulfadiazine

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Silver sulfadiazine
Silver sulfadiazine Silvadene.svg
Systematic (IUPAC) name
Silver [(4-aminophenyl)sulfonyl](pyrimidin-2-yl)azanide
Clinical data
Trade namesSilvadene
AHFS/Drugs.commonograph
MedlinePlusa682598
Pregnancy cat.
  • B (not recommended in late pregnancy)
Legal status
  • Prescription only
RoutesTopical
Pharmacokinetic data
Bioavailability<1% (silver), 10% (sulfadiazine)
Protein bindingHigh (silver)
Excretion2/3 renal (sulfadiazine)
Identifiers
CAS number22199-08-2 YesY
ATC codeD06BA01
PubChemCID 441244
DrugBankDB05245
ChemSpider390017 YesY
UNIIW46JY43EJR YesY
KEGGD00433 YesY
ChEBICHEBI:9142 YesY
ChEMBLCHEMBL1200766 N
Synonyms(4-Amino-N-2-pyrimidinylbenzenesulfonamidato-NN,01)-silver, sulfadiazine silver, silver (I) sulfadiazine, 4-amino-N-(2-pyrimidinyl)benzenesulfonamide silver salt, dermazine, geben, silvadene
Chemical data
FormulaC10H9AgN4O2S 
Mol. mass357.14 g/mol
Physical data
Melt. point285 °C (545 °F)
 N (what is this?)  (verify)
 
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Silver sulfadiazine
Silver sulfadiazine Silvadene.svg
Systematic (IUPAC) name
Silver [(4-aminophenyl)sulfonyl](pyrimidin-2-yl)azanide
Clinical data
Trade namesSilvadene
AHFS/Drugs.commonograph
MedlinePlusa682598
Pregnancy cat.
  • B (not recommended in late pregnancy)
Legal status
  • Prescription only
RoutesTopical
Pharmacokinetic data
Bioavailability<1% (silver), 10% (sulfadiazine)
Protein bindingHigh (silver)
Excretion2/3 renal (sulfadiazine)
Identifiers
CAS number22199-08-2 YesY
ATC codeD06BA01
PubChemCID 441244
DrugBankDB05245
ChemSpider390017 YesY
UNIIW46JY43EJR YesY
KEGGD00433 YesY
ChEBICHEBI:9142 YesY
ChEMBLCHEMBL1200766 N
Synonyms(4-Amino-N-2-pyrimidinylbenzenesulfonamidato-NN,01)-silver, sulfadiazine silver, silver (I) sulfadiazine, 4-amino-N-(2-pyrimidinyl)benzenesulfonamide silver salt, dermazine, geben, silvadene
Chemical data
FormulaC10H9AgN4O2S 
Mol. mass357.14 g/mol
Physical data
Melt. point285 °C (545 °F)
 N (what is this?)  (verify)

Silver sulfadiazine (INN, or silvadene) is a topical sulfonamide/silver[1] antibacterial used as a topical cream on burns. Studies have found that silver sulfadiazine may increase healing times – wounds may take longer to heal if treated with this drug and it is therefore not recommended by the authors of a Cochrane review.[2]

Silver sulfadiazine is typically delivered in a 1% cream or aqueous suspension. Brand names include Silvadene (a genericized trademark), Silverex, Silverol, Silvazine, Flamazine, Thermazene, BurnHeal, and SSD.[3]

It is on the World Health Organization's List of Essential Medicines, a list of the most important medication needed in a basic health system.[4]

Medical uses[edit]

A 2012 review found that topical silver worsens healing time compared to controls and showed no evidence of effectiveness in preventing wounds infection.[5] A Cochrane systematic review from 2008 found that most of the trials had methodological shortcomings and thus are of little use.[6] Another Cochrane systematic review from 2010 concluded that "There is insufficient evidence to establish whether silver-containing dressings or topical agents promote wound healing or prevent wound infection".[7] Other reviews of the evidence have also concluded that the "quality of the trials was limited".[8] Cochrane has raised concerns about delays in time to wound healing and an increased number of dressing applications when SSD is used.[6]

Adverse effects[edit]

An aseptic exudate (a clear fluid) may form on the wound's surface. Burning and painful sensations are not uncommon but only temporary.

About 0.1 to 1% of patients show hypersensitivity reactions like rashes or erythema multiforme.[9] This is a reaction known from other sulfonamides including antibacterials, thiazide diuretics, and sulfonylurea antidiabetics; but data on the likelihood of cross-allergies are inconsistent.

Incorporation of the silver ions can lead to local argyria (discoloration of the skin), especially if the treated area is exposed to ultraviolet. Generalised argyria with silver accumulation in kidneys, liver and retina has only been found in association with excessive long-term use, or repeated use on severe and heavily inflamed burns. Possible consequences of generalised argyria include interstitial nephritis and anemia.[9]

Interactions[edit]

Proteases like trypsin and clostridiopeptidase, which are contained in ointments used for the removal of dead skin on wounds, can be inhibited by silver ions if applied simultaneously. When silver sulfadiazine is absorbed in significant amounts, it can increase effects and side effects of some drugs like vitamin K antagonist.[9]

Pharmacokinetics[edit]

The chemical itself is poorly soluble, and has only very limited penetration through the skin. Only when applied to large area burns or other lesions is absorption into the body a problem.[9]

See also[edit]

References[edit]

  1. ^ Fisher NM, Marsh E, Lazova R (October 2003). "Scar-localized argyria secondary to silver sulfadiazine cream". J. Am. Acad. Dermatol. 49 (4): 730–2. doi:10.1067/S0190-9622(02)61574-9. PMID 14512929. 
  2. ^ Wasiak J, Cleland H, Campbell F (2008). "Dressings for superficial and partial thickness burns". Cochrane Database Syst Rev (4): CD002106. doi:10.1002/14651858.CD002106.pub3. PMID 18843629. The use of silver sulphadiazine (SSD) as a comparator on burn wounds for the full duration of treatment needs to be reconsidered, as a number of studies showed delays in time to wound healing and increased number of dressing applications in patients treated with SSD dressings 
  3. ^ http://www.drugs.com/mtm/ssd.html This source names Silvadene, SSD, SSD AF, Thermazene
  4. ^ "WHO Model List of EssentialMedicines". World Health Organization. October 2013. Retrieved 22 April 2014. 
  5. ^ Aziz, Z; Abu, SF; Chong, NJ (May 2012). "A systematic review of silver-containing dressings and topical silver agents (used with dressings) for burn wounds.". Burns : journal of the International Society for Burn Injuries 38 (3): 307–18. doi:10.1016/j.burns.2011.09.020. PMID 22030441. 
  6. ^ a b Wasiak J, Cleland H, Campbell F (2008). Wasiak, Jason, ed. "Dressings for superficial and partial thickness burns". Cochrane Database Syst Rev (4): CD002106. doi:10.1002/14651858.CD002106.pub3. PMID 18843629. 
  7. ^ Storm-Versloot, MN; Vos, CG; Ubbink, DT; Vermeulen, H (Mar 17, 2010). Storm-Versloot, Marja N, ed. "Topical silver for preventing wound infection". Cochrane database of systematic reviews (Online) (3): CD006478. doi:10.1002/14651858.CD006478.pub2. PMID 20238345. 
  8. ^ Lo SF, Hayter M, Chang CJ, Hu WY, Lee LL (2008). "A systematic review of silver-releasing dressings in the management of infected chronic wounds". Journal of clinical nursing 17 (15): 1973–85. doi:10.1111/j.1365-2702.2007.02264.x. PMID 18705778. 
  9. ^ a b c d Jasek, W, ed. (2007). Austria-Codex (in German) 2 (62 ed.). Vienna: Österreichischer Apothekerverlag. pp. 3270–1. ISBN 978-3-85200-181-4.