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Dear Readers! I started this blog when my daughter was in the NICU. She had ventriculitis. Her CSF report grew E.coli. But, she was injected Teicoplanin directly into her brain. The doctors made two errors here:

Teicoplanin is for gram-positive bacteria only. It does not treat E.coli.
Teicoplanin is not for intraventricular use. The manufacturer strongly discourage injecting Teicoplanin into the brain.

My daughter bled into the brain. She lived for another two years and ultimately died.

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Ferric subsulfate Paste - Uses, Side effects, MOA, Brands

Ferric subsulfate is also known as Monsel's solution or ferric sulfate solution, when applied topically over a wound, causes the agglutination of surface proteins resulting in hemostasis. The drug acts at a capillary level and should not be used to stop bleeding when bleeding is arteriolar or arterial that requires pressure to stop it. The drug either forms a clot over the bleeding site or make a matrix over the wound. In 2018, the FDA recalled all lots of Monsel's solution because of the preparation of the drug under poor sanitary conditions [Ref].

Ferric subsulfate Uses:

It acts as a hemostatic in minor surgical procedures.

Ferric subsulfate Dose in Adults

Ferric subsulfate Dose in the Hemostasis:

Apply topically to the wound evenly.

Dose in Children:

Apply evenly over the wound.

Use in Pregnancy and lactation:

After cervical biopsies, it is used to provide hemostatic relief.
Vaginal pain can occur if the solution leaks.
According to case reports, it was also used for hemostasis after miscarriage.

Dose in Kidney Disease:

Adjustment in the dose has not been provided in the manufacturer’s labeling.

Dose in Liver disease:

Adjustment in the dose has not been provided in the manufacturer’s labeling.

Side effects of Ferric subsulfate:

Dermatologic:
- Skin hyperpigmentation (application site)

Contraindications to Ferric subsulfate:

There are no contraindications for its use, according to the manufacturer.

Warnings and precautions

Hyperpigmentation
- Hyperpigmentation may occur at the application site, which may lead to misinterpretation of the histopathology and radiological artifacts.

Monitoring parameters:

Monitor for hemostasis at the site of application.

How to administer Ferric subsulfate?

It is administered topically (for external use only).
Avoid contact with eyes. It may be administered over the wound using a cotton swab.

Mechanism of action of Ferric subsulfate:

It results in the formation of a meshwork that causes hemostasis by agglutinating the surface proteins at the site. Within 20 seconds, hemostatic action begins.