Rayasore Kit (silver sulfadiazine/povidone-iodine/alginate dressing)

Iodine solution and tincture are applied topically to the affected areas as necessary; to avoid irritation, surfaces to which the preparations are applied should not be covered.

Silver sulfadiazine, as a 1% cream, is applied topically to cleansed, debrided, burned areas once or twice daily using a sterile-gloved hand. The cream should be applied to a thickness of approximately 16 mm (one-sixteenth inch); the burned area should be covered with cream at all times. If necessary, the cream should be reapplied to any areas from which it has been removed by patient activity. If possible, the patient should be bathed daily to aid in debridement. Dressings are usually not required but may be used. Silver sulfadiazine cream should be applied to the burn wound as long as there is a possibility of infection, unless a clinically important adverse reaction occurs. Therapy is usually continued until healing is progressing well or until the site is ready for grafting.

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There are no contraindication interactions for this drug.

Severe Interaction: Action is required to reduce the risk of severe adverse interaction.

Agents That Affect Iodide/Radioactive Iodide

SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.

MECHANISM OF ACTION: Many compounds can affect iodide protein binding and alter iodide pharmacokinetics and pharmacodynamics.(1)

CLINICAL EFFECTS: Compounds that affect iodide pharmacokinetics and pharmacodynamics may impact the effectiveness of radioactive iodide.(1)

PREDISPOSING FACTORS: Compounds that affect iodide pharmacokinetics and pharmacodynamics are expected to have the most impact during therapy using radioactive iodide. Diagnostic procedures would be expected to be impacted less.

PATIENT MANAGEMENT: Discuss the use of agents that affect iodide pharmacokinetics and pharmacodynamics with the patient's oncologist.(1) Because indocyanine green contains sodium iodide, the iodine-binding capacity of thyroid tissue may be reduced for at least one week following administration. Do not perform radioactive iodine uptake studies for at least one week following administration of indocyanine green.(2) The manufacturer of iopamidol states administration may interfere with thyroid uptake of radioactive iodine and decrease therapeutic and diagnostic efficacy. Avoid thyroid therapy or testing for up to 6 weeks post administration of iopamidol.(3)

DISCUSSION: Many agents interact with radioactive iodine. The average duration of effect is: anticoagulants - 1 week antihistamines - 1 week anti-thyroid drugs, e.g: carbimazole, methimazole, propylthiouracil - 3-5 days corticosteroids - 1 week iodide-containing medications, e.g: amiodarone - 1-6 months expectorants - 2 weeks Lugol solution - 3 weeks saturated solution of potassium iodine - 3 weeks vitamins - 10-14 days iodide-containing X-ray contrast agents - up to 1 year lithium - 4 weeks phenylbutazone - 1-2 weeks sulfonamides - 1 week thyroid hormones (natural or synthetic), e.g.: thyroxine - 4 weeks tri-iodothyronine - 2 weeks tolbutamide - 1 week topical iodide - 1-9 months (1)

Agents That Affect Iodide/Sodium Iodide I 131

SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.

MECHANISM OF ACTION: Many compounds can affect iodide protein binding and alter iodide pharmacokinetics and pharmacodynamics.(1,2)

CLINICAL EFFECTS: Compounds that affect iodide pharmacokinetics and pharmacodynamics may impact the effectiveness of radioactive iodide.(1,2)

PREDISPOSING FACTORS: Compounds that affect iodide pharmacokinetics and pharmacodynamics are expected to have the most impact during therapy using radioactive iodide. Diagnostic procedures would be expected to be impacted less.

PATIENT MANAGEMENT: Discuss the use of agents that affect iodide pharmacokinetics and pharmacodynamics with the patient's oncologist.(1,2) Because indocyanine green contains sodium iodide, the iodine-binding capacity of thyroid tissue may be reduced for at least one week following administration. Do not perform radioactive iodine uptake studies for at least one week following administration of indocyanine green.(3) The manufacturer of iopamidol states administration may interfere with thyroid uptake of radioactive iodine and decrease therapeutic and diagnostic efficacy. Avoid thyroid therapy or testing for up to 6 weeks post administration of iopamidol.(4)

DISCUSSION: Many agents interact with radioactive iodine. The average duration of effect is: anticoagulants - 1 week antihistamines - 1 week anti-thyroid drugs, e.g: carbimazole, methimazole, propylthiouracil - 3-5 days corticosteroids - 1 week iodide-containing medications, e.g: amiodarone - 1-6 months expectorants - 2 weeks Lugol solution - 3 weeks saturated solution of potassium iodine - 3 weeks vitamins - 10-14 days iodide-containing X-ray contrast agents - up to 1 year lithium - 4 weeks phenylbutazone - 1-2 weeks sulfonamides - 1 week thyroid hormones (natural or synthetic), e.g.: thyroxine - 4 weeks tri-iodothyronine - 2 weeks tolbutamide - 1 week topical iodide - 1-9 months (1,2)

Topical Heavy Metals/Topical Collagenase; Papain

SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.

MECHANISM OF ACTION: Heavy metal ions may inactivate collagenase(1) and papain(2-10).

CLINICAL EFFECTS: Application of heavy metal ions such as lead, mercury, and silver may inactivate collagenase(1) and papain,(2-8) limiting their effectiveness.

PREDISPOSING FACTORS: None determined.

PATIENT MANAGEMENT: Avoid applying topical products that contain heavy metals such as lead, mercury, or silver to the same wound areas as collagenase(1) and papain.(2-10)

DISCUSSION: The enzymatic activity of collagenase is adversely affected by heavy metal ions such as mercury and silver, which are used in some antiseptics.(1) Papain may be inactivated by heavy metal ions such as lead, mercury, and silver.(2-10)

Topical Silver/Topical Sodium Sulfacetamide

SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.

MECHANISM OF ACTION: Topical sodium sulfacetamide and topical silver are physically incompatible.(1,2)

CLINICAL EFFECTS: Concurrent application of topical sodium sulfacetamide and topical silver preparations may result in decreased clinical effectiveness of the products.(1,2)

PREDISPOSING FACTORS: None determined.

PATIENT MANAGEMENT: Avoid using topical silver preparations on the same location as topical sodium sulfacetamide products.(1,2)

DISCUSSION: Topical sodium sulfacetamide and topical silver are physically incompatible.(1,2)

Moderate Interaction: Assess the risk to the patient and take action as needed.

Antimicrobial Topicals/Keratinocyte-Fibroblast Skin Tissue

SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.

MECHANISM OF ACTION: Antimicrobial topicals or dressings containing chlorhexidine, mafenide, or silver may decrease the viability of keratinocytes and fibroblasts used for wound healing in skin tissue replacement products.

CLINICAL EFFECTS: The use of antimicrobial topicals or dressings containing chlorhexidine, mafenide, or silver may disrupt the integrity of keratinocyte human skin substitutes and decrease the viability of keratinocytes and fibroblasts.

PREDISPOSING FACTORS: None determined.

PATIENT MANAGEMENT: The use of antimicrobial topicals or dressings containing chlorhexidine, mafenide, or silver is not recommended.

DISCUSSION: Mafenide acetate has been shown to reduce keratinocyte viability and disrupt the integrity of tissue-engineered human skin substitutes. In vitro data suggest silver may decrease the viability of keratinocytes and human dermal fibroblasts. Chlorhexidine has been shown to be toxic to keratinocytes and human dermal fibroblasts.(1)

There is no enhanced messaging for this drug.

• Hemolytic anemia from pyruvate kinase and g6PD deficiencies
• Pregnancy

• Porphyria

• Anemia
• Disease of liver
• Kidney disease with reduction in glomerular filtration rate (GFr)
• Leukopenia
• Thrombocytopenic disorder

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Rare or Very Rare

• Agranulocytosis
• Aplastic anemia
• Erythema multiforme
• Exfoliative dermatitis
• Hemolytic anemia
• Interstitial nephritis
• Leukopenia
• Stevens-johnson syndrome
• Thrombocytopenic disorder
• Toxic epidermal necrolysis

Less Frequent

• Pruritus of skin
• Stinging of skin

Rare or Very Rare

• Dyschromia
• Skin photosensitivity
• Skin rash

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No enhanced messaging available.

Reproduction studies in rabbits using silver sulfadiazine 3-10 times the usual human dosage have not revealed evidence of harm to the fetus. There are no adequate and controlled studies to date using silver sulfadiazine in pregnant women, and the drug should be used during pregnancy only when clearly needed. The drug is not recommended for use in pregnant women unless the burned area covers more than 20% of the body surface or the therapeutic benefits to the patient outweigh the possible risks to the fetus. Because sulfonamide therapy has produced kernicterus in neonates, silver sulfadiazine cream is contraindicated in pregnant women approaching or at term.

It is not known whether silver sulfadiazine is distributed into human milk. Because sulfonamides are distributed into milk and sulfonamides may cause kernicterus in infants younger than 2 months of age, silver sulfadiazine should be used with caution in nursing women.

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