Generic Name: silver nitrate

Drug Class: Topical Antimicrobials

What is silver nitrate, and what is it used for?

Silver nitrate is a chemical compound of silver cation and nitrate anion. Ions are charged particles, cations are positively charged and anions are negatively charged. Silver nitrate solution is used topically as an anti-infective agent to:

• Cauterize infected wound tissue, a procedure that destroys the infected cells on wounds
• Remove warts and excess granulation tissue, a type of tissue with new blood vessels that forms in wound repair phase

Silver nitrate can protect wounds from bacterial infection and inhibit the growth of both gram-positive and gram-negative bacteria, the two main classifications of bacteria based on their structure. Silver ions react with the bacterial proteins and alter the structure of the bacterial cell wall and membrane, killing them in the process. Silver ions coagulate the proteins in the wound tissue forming a layer of dead tissue (eschar), which stops bleeding, facilitates wound closure and healing, and also prevents the penetration of silver nitrate into deeper tissue.

Silver nitrate is available as a prescription medication but is not approved by the FDA. Uses of silver nitrate include:

• Cauterization of infected tissue around skin wounds
• Removal of warts, skin tags, and granulation tissue
• Cauterization of wounds in mucous membranes including:
  • Small ulcers in the mouth
  • Infected tonsils
  • Vaginal or cervical ulcerations and erosions
  • Rectal fissures and fistulae
• Superior limbic keratoconjunctivitis, a condition that causes chronic inflammation in the area above the cornea in the eye

Warnings

• Do not use in patients with known hypersensitivity to silver nitrate
• Silver nitrate is corrosive and can cause chemical burns; wear chemical-resistant gloves and other appropriate personal protective equipment while applying and take care to restrict application to only the affected area
• Do not apply on broken skin, open wounds or cuts
• Silver nitrate can irritate the skin and mucous membrane; avoid prolonged contact with skin, particularly on thin delicate skin and babies’ skin
• Silver nitrate can stain the skin black, which generally disappears gradually within two weeks

What are the side effects of silver nitrate?

Common side effects of silver nitrate include:

• Discoloration of skin
• Local irritation and burning on the application site
• Methemoglobinemia, a condition with excessive blood level of methemoglobin, a form of hemoglobin that doesn’t transfer oxygen effectively to the tissues

This is not a complete list of all side effects or adverse reactions that may occur from the use of this drug.

Call your doctor for medical advice about serious side effects or adverse reactions. You may also report side effects or health problems to the FDA at 1-800-FDA-1088.

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What are the dosages of silver nitrate?

Topical solution

• 0.5%
• 10%
• 25%
• 50%

Applicator sticks

• 75%

Adult and Pediatric:

Antiseptic Wound Cauterization

• Sticks: Apply to mucous membranes and other moist skin surfaces only on the area to be treated
• Topical solution: Apply a cotton applicator dipped in solution/ointment on the affected area 2-3 times per week for 2-3 weeks

Only adult:

Superior Limbic Keratoconjunctivitis (Off-label)

• Apply 0.5-1% solution to anesthetized upper tarsus (inner eyelid area above the lid margin), allow it to fall back into place over the affected palpebral conjunctiva
• Irrigate with sterile saline after 1 minute
• It may be repeated after 4-6 weeks

Overdose

• Excess application of silver nitrate can be neutralized by treating the area with saline solution and rinsing it with sterile water.

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What drugs interact with silver nitrate?

Inform your doctor of all medications you are currently taking, who can advise you on any possible drug interactions. Never begin taking, suddenly discontinue, or change the dosage of any medication without your doctor’s recommendation.

• Silver nitrate has no known severe interactions with other drugs.
• Silver nitrate has no known serious interactions with other drugs.
• Moderate interactions of silver nitrate include:
  • collagenase
  • papain
  • sodium sulfacetamide
  • sulfacetamide topical
  • trypsin
• Silver nitrate has no known minor interactions with other drugs.

The drug interactions listed above are not all of the possible interactions or adverse effects. For more information on drug interactions, visit the RxList Drug Interaction Checker.

It is important to always tell your doctor, pharmacist, or health care provider of all prescription and over-the-counter medications you use, as well as the dosage for each, and keep a list of the information. Check with your doctor or health care provider if you have any questions about the medication.

Pregnancy and breastfeeding

• There are no well-controlled studies on silver nitrate use in pregnant women. Use if potential benefits to the mother outweigh possible risks to the fetus.
• There are no studies on use of silver nitrate in nursing mothers; avoid use.

What else should I know about silver nitrate?

• Silver nitrate is to be used only topically; do not take orally, it can cause severe gastroenteritis that may be fatal; in case of accidental ingestion, seek medical help immediately or contact Poison Control 
• Do not use applicator sticks on eye and topical solution on mucous membranes
• Use extreme care in handling silver nitrate; it is a corrosive substance
• Keep silver nitrate safely out of reach of children