Silver Sulfadiazine Cream (Flamazine) for Burns - Dose, Brands, MOA

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:

  • 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.
  • Systemic effects

    • Systemic effects may be caused by significant systemic absorption.
  • 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.

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