Due to its antibacterial qualities, Silver Sulfadiazine Cream (Flamazine) is applied to patients with second and third-degree burns in order to treat and prevent infection.
Silver sulfadiazine Cream Uses:
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Burn treatment:
- When treating and preventing wound infections in patients with second and third-degree burns, it serves as an adjuvant.
Dose in Adults
Silver Sulfadiazine Cream (Flamazine) Dose for burns in adults:
- The burning area must always be protected. It is possible to reapply the cream if it is mistakenly removed or as necessary.
- Until healing has taken place and the burnt region is prepared for skin grafting, the therapy should be continued.
- Once or twice a day, it is topically administered to a thickness of 1/16 inch.
- If there is a chance of infection, the therapy shouldn't be stopped till a negative medication reaction is noticed.
Dose in Children
Note:
- Until healing has taken place and the burnt region is prepared for skin grafting, the therapy should be continued.
- If there is a chance of infection, the therapy shouldn't be stopped till a negative medication reaction is noticed.
Silver Sulfadiazine Cream (Flamazine) Dose for burns in children:
-
Infants older than 2 months, Children, and Adolescents:
- It is applied topically to a thickness of 1/16 inch once or twice daily.
- The burning area must always be protected. It is possible to reapply the cream if it is mistakenly removed or as necessary.
Pregnancy Risk Category: B
- Animal reproduction studies have not shown adverse pregnancy outcomes.
- Silver sulfadiazine may cause hyperbilirubinemia or kernicterus in pregnant women, infants under 2 months old, premature infants and infants.
Use during breastfeeding:
- When the medication was administered across a sizable region of skin, significant systemic concentrations had been seen.
- In particular, if the medication has been administered to a tiny region, it is unclear if it will be excreted in breast milk.
- The manufacturer recommends that you stop breastfeeding. This is based on the risk of your infant being exposed to the drug and possible adverse reactions.
- Sulfadiazine should not be used orally, especially by nursing women. It can enter breast milk and give birth to kernicterus in the baby.
Dose in Kidney Disease:
There are no dosage adjustments provided in the manufacturer's labeling. Use with caution as drug accumulation may occur.
Dose in Liver disease:
There are no dosage adjustments provided in the manufacturer's labeling; Use with caution as drug accumulation may occur.
Side effects of Silver Sulfadiazine cream (Flamazine):
-
Hypersensitivity:
- Hypersensitivity reaction (may be related to sulfa component)
-
Dermatologic:
- Skin photosensitivity
- Skin rash
- Erythema multiforme
- Pruritus
- Skin discoloration
-
Hepatic:
- Hepatitis
-
Hematologic & oncologic:
- Hemolytic anemia
- Agranulocytosis
- Aplastic anemia
- Leukopenia
-
Renal:
- Interstitial nephritis
Contraindications to Silver Sulfadiazine cream (Flamazine):
- Premature infants and neonates are those who are less than 2 months old
- Patients who are allergic to sulfa drugs.
- Silver sulfadiazine and any other formulation component allergies
- Women who are expecting or who intend to get pregnant soon
- Cross-sensitivity can occur in patients allergic to sulfa drugs.
Warnings and precautions
-
Allergy to sulfonamide
- Chemically, sulfuramides, loop diuretics, carbonic anhydrase inhibitors, thiazides and sulfonylureas are all chemically identical, except ethacrynic acids.
- Patients who are allergic to sulfa medications shouldn't take it. Patients who are allergic to other sulfa medications shouldn't use it.
-
Superinfection
- Long-term use can lead to serious fungal and bacterial superinfections. It is possible for fungal proliferation to occur below and within the eschar.
- CDAD (C. difficile -associated diarrhea) or pseudomonas colitis can rarely be caused by prolonged use of the drug. CDAD can occur even after the last two-month-old dose of antibiotics.
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Systemic effects
- Systemic effects may be caused by significant systemic absorption.
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G6PD deficiency:
- Patients with G6PD deficiency may experience hemolysis. These patients should not use it.
-
Hepatic impairment
- Patients with impaired liver function may be at risk of accumulating sulfadiazine. Patients with liver impairment should use it with caution.
-
Renal impairment
- Patients with impaired renal function may be at risk of accumulating sulfadiazine. These patients should be cautious when using sulfadiazine.
Silver sulfadiazine: Drug Interaction
Risk Factor C (Monitor therapy) |
|
BCG Vaccine (Immunization) |
The therapeutic benefit of the BCG vaccine may be reduced by antibiotics (Immunization). |
Risk Factor D (Consider therapy modification) |
|
Sodium Picosulfate |
Antibiotics may reduce Sodium Picosulfate's therapeutic impact. Management: If a patient previously used or is currently using an antibiotic, Consider using a different bowel cleansing product before a colonoscopy. |
Risk Factor X (Avoid combination) |
|
BCG (Intravesical) |
Antibiotics may diminish the therapeutic effect of BCG (Intravesical). |
Cholera Vaccine |
Antibiotics may diminish the therapeutic effect of the Cholera Vaccine. Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days following the use of oral or parenteral antibiotics. |
Monitoring parameters:
- Serum electrolytes
- Urinalysis
- Renal function tests
- CBC in patients receiving long-term care for severe burns.
- Serum sulfa levels, if clinically necessary.
How to administer Silver Sulfadiazine cream (Flamazine)?
- It is indicated for topical use only. Contact with mucosal surfaces and eyes should be avoided.
- Applying it needs to be done with sanitary gloves on. It is important to cover all the burned areas with the medicine all the time.
- If the cream has been removed, it should be reapplied. Patients may use dressings over the area. The cream should be reapplied after hydrotherapy.
Mechanism of action of Silver Sulfadiazine (Flamazine):
Numerous species can be killed by it by having an impact on their cell membranes. Yeast, gram-positive, and gram-negative cells are all susceptible to its effects. The following organisms are resistant to it.
- Enterobacter species
- Escherichia coli
- Proteus mirabilis
- Corynebacterium diphtheriae
- Clostridium perfringens
- Morganella morganii
- Providencia rettgeri
- Pseudomonas aeruginosa
- Pseudomonas maltophilia
- Klebsiella species
- Staphylococcus aureus
- Staphylococcus epidermidis
- Proteus vulgaris
- Providencia species
- Citrobacter species
- Enterococcus species
- Candida albicans
- Serratia species
- Acinetobacter calcoaceticus
Absorption:
- When applied to both normal skin and severe and superficial burns, negligible)
- Blister removal increases absorption.
Half-life elimination:
- Sulfadiazine: About 24 hours.
Excretion:
- Silver: sluggish excretion rate in the faeces; sulfadiazine: 6.6% of urine in 5 days.
International Brand Names of Silver sulfadiazine:
- Silvadene
- SSD
- Dermazin
- Flamazine
- Aldo-Silvederma
- Argentafil
- Argentamicina
- Argenzil
- Bactin
- Bactrazine
- Burnazin
- Burnsil
- Burnzorb
- Canflame
- Dermazin
- Diasilve
- Falmmazine
- Flamazine
- Flammazine
- Flugen
- No-Burn
- Platsul-A
- Silbecor
- Silmazin
- Silvadene
- Silvadex
- Silvadiazin
- Silvadiazine
- Silvadin
- Silvederma
- Silverderm
- Silverdiazina
- Silverin
- Silvex
- Silvirin
- Silzine
- Sofargen
- Sterizol
- Sulfadiacina de Plata
- Sulfaplata
- Sulfargin
- Sulfasil
- Synvodex
Silver sulfadiazine Brand Names in Pakistan:
Silver Sulphadiazine Cream 1 %w/v in Pakistan |
|
Silvadene | Reliance Pharma |
Silver Sulphadiazine Cream 1 %w/w in Pakistan |
|
Bio Sul | Bio Labs (Pvt) Ltd. |
Burnasil | Bloom Pharmaceuticals (Pvt) Ltd. |
Curazine | Epoch Pharmaceutical |
Dermazin | Novartis Pharma (Pak) Ltd |
Dermoflam | Mediceena Pharma (Pvt) Ltd. |
Flamazine | Bsn Medical (Pvt) Ltd. |
Flamoff | Valor Pharmaceuticals |
Lp-Zine | Lahore Pharma |
M-Zine | Mediate Pharmaceuticals (Pvt) Ltd |
Quench | Ferozsons Laboratoies Ltd. |
Savion | Nimrall Laboratories |
Silcream | Life Line Pharmaceuticals (Pvt.) Ltd. |
Sildaflo Cream | Friends Pharma (Pvt) Ltd |
Silsul | Sharex Laboratories (Pvt.) Ltd. |
Silsuzine | Elite Pharma |
Silvate | Glaxosmithkline |
Silvazin | Pharmawise Labs. (Pvt) Ltd. |
Silvederma | Genesis Pharmaceuticals (Pvt) Ltd. |
Silver-Queen | Baxter Karachi |
Silvin | P.D.H. Pharmaceuticals (Pvt) Ltd. |
Silvitex | Syntex Pharmaceuticals |
Sisuzine | Elite Pharma |
Skinsafe | Z-Jans Pharmaceutical (Pvt) Ltd. |
Sulfadiz | Prays Pharmaceuticals |
Sulphazine | Swiss Pharmaceuticals (Pvt) Ltd. |
Sulzin | Biogen Pharma |
Vee Burna Fax | Venus Pharma |
Xeburn | Xenon Pharmaceuticals (Pvt) Ltd. |
Silver Sulphadiazine Spray 1 %w/v in Pakistan |
|
Silvederma | Genesis Pharmaceuticals (Pvt) Ltd. |