Ferric subsulfate is also known as Monsel's solution or ferric sulfate solution, when applied topically over a wound, causes the agglutination of surface proteins resulting in hemostasis. The drug acts at a capillary level and should not be used to stop bleeding when bleeding is arteriolar or arterial that requires pressure to stop it. The drug either forms a clot over the bleeding site or make a matrix over the wound. In 2018, the FDA recalled all lots of Monsel's solution because of the preparation of the drug under poor sanitary conditions [Ref].

Ferric subsulfate Uses:

• It acts as a hemostatic in minor surgical procedures.

Ferric subsulfate Dose in Adults

Ferric subsulfate Dose in the Hemostasis:

• Apply topically to the wound evenly.

Dose in Children:

Apply evenly over the wound.

Use in Pregnancy and lactation:

• After cervical biopsies, it is used to provide hemostatic relief.
• Vaginal pain can occur if the solution leaks.
• According to case reports, it was also used for hemostasis after miscarriage.

Dose in Kidney Disease:

Adjustment in the dose has not been provided in the manufacturer’s labeling.

Dose in Liver disease:

Adjustment in the dose has not been provided in the manufacturer’s labeling.

Side effects of Ferric subsulfate:

• Dermatologic:

  • Skin hyperpigmentation (application site)

Contraindications to Ferric subsulfate:

There are no contraindications for its use, according to the manufacturer.

Warnings and precautions

• Hyperpigmentation

  • Hyperpigmentation may occur at the application site, which may lead to misinterpretation of the histopathology and radiological artifacts.

Monitoring parameters:

• Monitor for hemostasis at the site of application.

How to administer Ferric subsulfate?

• It is administered topically (for external use only).
• Avoid contact with eyes. It may be administered over the wound using a cotton swab.

Mechanism of action of Ferric subsulfate:

It results in the formation of a meshwork that causes hemostasis by agglutinating the surface proteins at the site. Within 20 seconds, hemostatic action begins.

International Brand Names:

• Astringyn
• Monsels Solution

Brand Names in Pakistan:

No Brands Available in Pakistan.