Version May 2024
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:
AzaDrox, BasaDrox: Apply on a clean applicator (eg, tongue depressor, gauze) in a sufficient amount to liberally cover the wound; cover with gauze wrap or nonadherent dressing if needed; remove product within 24 hours.
Collatyl, Protyl Ag: Apply into wound site and surrounding area; cover with nonadherent dressing; reapply and redress as needed.
RevitaDERM, SilvaSorb, 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.
There are no dosage adjustments provided in the manufacturer’s labeling. However, dosage adjustment unlikely due to low systemic absorption.
There are no dosage adjustments provided in the manufacturer’s labeling. However, dosage adjustment unlikely due to low systemic absorption.
Refer to adult dosing.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
Frequency not defined.
Dermatologic: Allergic skin reaction, erythema, skin cyanosis, local discoloration (temporary black discoloration at application site)
Local: Application site irritation
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
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).
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)
AzaDrox: (5 mL)
Collatyl: (42 g [DSC])
Protyl Ag: 1% (42 g [DSC])
SilvaSorb: (44.4 mL [DSC])
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 [DSC]); 4"X5" (1 ea [DSC]); 4"X8" (1 ea [DSC]); 8"X8" (1 ea [DSC])
May be product dependent
Pads (Silverseal Hydrogel Dressing External)
2"X3" (per each): $13.42
4"X5" (per each): $26.84
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Topical: For external use only; not for ophthalmic or oral use.
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.
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).
None known.
There are no known significant interactions.
Although systemic absorption following topical application is considered to be low, use in pregnancy is not currently recommended (International Consensus, 2012)
Although systemic absorption following topical application is considered to be low, use in nursing women is not currently recommended (International Consensus, 2012)
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).
Absorption: Little systemic absorption (International Consensus, 2012)
Excretion: Feces (primarily) and urine (International Consensus, 2012)
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