Ammoniated Mercury (Topical)

As an inorganic compound created from a reaction between mercuric chloride and ammonia, ammoniated mercury is commonly used as a topical anti-septic and disinfectant cream.

Overview:

Ammoniated mercury is a topical cream which is effective in the treatment of various mild to moderate skin conditions. It is available without prescription and can be utilised to alleviate symptoms of dandruff, psoriasis, scaly or oily skin and acne. Although it is regarded as a useful ointment for treating skin conditions, some doctors may advise against topical use on account of the propensity for side effects associated with mercury.

Despite this, its use throughout the US and Europe is still widespread due to its efficacy and mild anti-septic properties, which can help patients to experience less redness, itchiness and pain associated with certain skin conditions.

Conditions treated:

  • Acne
  • Skin infection
  • Impetigo
  • Dandruff

Type of medicine:

  • Topical cream

Side effects:

Along with its desired effects, ammoniated mercury also has the propensity to cause unwanted side effects. Although not all side effects associated with this medication will occur, some of those that do may require medical attention if severe enough to cause discomfort. The most common symptoms associated with ammoniated mercury include skin rash, unusual redness in the skin, soreness, swelling or irritation of gums, nausea, and/or cloudy urine.

When used as directed by a pharmacist or qualified health professional, most patients will only experience very minimal side effects, if any, when applying topical ammoniated mercury. The drug is designed to alleviate many of the symptoms associated with its side effects, and most (if not all of these) should subside after regular treatment with the ointment.

Because this compound contains mercury, which is an element that can cause potentially fatal toxic reactions, patients are advised to be aware of the symptoms associated with mercury poisoning prior to initiating treatment with ammoniated mercury.

Mercury is a naturally occurring element. It is often found in the food chain and at low levels it does not cause any issues in humans. Ammoniated mercury is a compound which combines ammonia with the metal. It is useful in the treatment of skin conditions, although it should only be used as directed by a physician.

Mercury exposure at a particularly high level has the potential to cause serious harm to the heart, brain, lungs, kidneys and the immune system. Some of the most prominent symptoms of mercury poisoning include:

  • Lack of coordination
  • Muscle weakness
  • Difficulty walking
  • Difficulty hearing (deafness)
  • Difficulty talking and communicating

Acute mercury poisoning can be even more serious, and symptoms associated with it include:

  • Insomnia
  • Emotional changes
  • Tremors
  • Headaches
  • Changes to nerve responses
  • Low cognitive function

At acute levels, mercury poisoning can result in respiratory failure, kidney failure and even death. Patients who believe they may have been overexposed to mercury via a topical cream are advised to consult a doctor or qualified health professional who will advise on how to test for mercurial toxicity. Tests may involve tests on the blood, hair and urine, and treatment typically involves the removal of the source of mercury exposure, abstaining from using ammoniated mercury, supportive care and chelation therapy which helps to remove heavy metals from the body.

Dosage:

Doses will vary dependent on the physiology of the patient, and the severity of the skin condition. As with all medicines, creams and ointments, it is incredibly important for patients to only use ammoniated mercury as advised by a physician or pharmacist. Although the drug is available as an over the counter topical treatment, patients should only use it at the dosage and frequency recommended by their healthcare professional, and to discontinue use when advised, even if they still have a supply of the cream remaining.

As a topical cream, ammoniated mercury applied to affected areas of the skin in order to alleviate conditions such as dandruff, psoriasis, impetigo and more. The cream is available in a variety of different strengths. Some patients may only require a weak version of the compound, whereas others with more severe symptoms might benefit from more concentrated versions of the cream.

For bacterial infections, adults are advised to apply ammoniated mercury to the affected areas of the skin, once or twice daily, until symptoms subside. Use on children is not recommended.

If the patient forgets to apply a dose of ammoniated mercury, it can be applied as soon as is feasible. However, if it is nearly time to apply the next dose, the patient is advised to skip the missed dose and continue with the regular schedule of application from the next dose onwards. It is not advisable to use double doses in place of a missed dose, nor is it practical on account of having to apply the medicine as a cream.

Ammoniated mercury ointment should be applied liberally, with enough ointment to cover the affected area, and rubbed in gently until transparent or translucent. This will result in more of the ointment being absorbed by the skin.

Interactions:

All drugs have the propensity to interact with other medications or chemicals present in the human body, and this can potentially change the effects each medication has. In some instances, interactions may result in potentially harmful side effects. Because of this, it is important for patients to keep a detailed list of all medicines they are currently taking. This extends to over the counter medications, herbal supplements and vitamins as well as prescribed drugs.

Below is a partial list of medications know to have negatively interacted with ammoniated mercury in a number of people. Patients who are currently receiving treatment with any of these medicines should consider avoiding the use of ammoniated mercury, or consult their doctor before doing so:

  • Avage
  • Avita
  • Altinac
  • Absorica
  • Amnesteem
  • Claravis
  • Flucinolone
  • Fabior
  • Mequinol
  • Myorisan
  • Obagi
  • Refissa
  • Solage
  • Veltin
  • Vitinoin
  • Zenatane
  • Ziana

In addition to avoiding these medications in conjunction with ammoniated mercury where possible, patients should also avoid any other medicine which includes mercury or mercury-related compounds, as this can increase the risk of mercurial poisoning. Eating mercury-containing fish when undergoing treatment with this medicine also has the potential to induce overdose. The risk is negligible, however care should be taken to avoid the potential for harm whenever possible.

Warnings:

Patients should avoid administering topical ammoniated mercury to broken skin or open wounds. The body is more likely to absorb excess mercury via these routes, and patients are therefore advised to wait until sores or wounds have healed before re-administering ammoniated mercury.

Ammoniated mercury is not suitable for the treatment of serious burns. Applying the cream to burns has the potential to cause mercury poisoning as well as irritating the skin even further. In the event of experiencing serious burns, patients are advised to seek emergency medical treatment at a health center.

This medicine may not be suitable for certain individuals, including those who currently have one or more mercury or cadmium-related dental fillings, as the potential for mercury poisoning could be increased.

Ammoniated mercury should be kept away from the eyes. In the event of getting this cream in the eyes, the patient should rinse the affected area with warm water.

In the event of using too much of the cream, overdose or mercury poisoning may occur. Patients who suspect they may have used too much of this medicine should contact their local disease control center on 1800-222-1222, or the emergency services on 911.

Storage:

Ammoniated mercury is typically supplied in a glass or plastic jar or foil tube. It should be stored at room temperature, in a cool and dry place, out of the reach of children.

When disposing of this medication, it should not be flushed down the toilet or poured down the drain. It should be disposed of in a safe and hygenic manner, so that it does not pose a risk to children or animals.

For further information on how to dispose of unwanted medications, patients are advised to contact their pharmacist or local waste disposal experts who will be able to provide further tips on the best possible way to dispose of unwanted or discarded ammoniated mercury. Some pharmacies may operate a tack-back scheme, where sealed and unused medicines can be repurposed and re-used.

Summary:

Although newer topical ointments with less potential side effects are available as over the counter treatments, ammoniated mercury remains a popular treatment for skin conditions on account of its efficacy at reasonably small levels.

Some qualified health professionals consider ammoniated mercury ointments as outdated, on account of the weak potency of mercury as an anti-septic agent. Severe side effects associated with mercury, including poisoning, high irritancy and allergic potential make this medicine a poor choice for some patients, although in some instances it is a practical choice, as evidenced by the fact that it is still carried by the majority of high street pharmacies and drug stores throughout the US, UK and Europe.

Resources
Last Reviewed:
December 10, 2017
Last Updated:
April 04, 2018