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Pronunciation
(dye mer KAP role)
U.S. Brand Names
Index Terms
Generic Available
No
Pharmacologic Category
Use
Antidote to gold, arsenic (except arsine), or acute mercury poisoning (except nonalkyl mercury); adjunct to edetate calcium disodium in lead poisoning
Pregnancy Risk Factor
C
Pregnancy Implications
Animal reproduction studies have not been conducted. There are no adequate and well-controlled studies in pregnant women.
Lactation
Excretion in breast milk unknown/use caution
Contraindications
Hypersensitivity to dimercaprol or any component of the formulation
Hepatic insufficiency (unless due to arsenic poisoning); iron, cadmium, or selenium poisoning
Warnings/Precautions
Concerns related to adverse effects:
• Nephrotoxicity: Potentially a nephrotoxic drug; use with caution in patients with oliguria. Keep urine alkaline to protect kidneys (prevents dimercaprol-metal complex breakdown).
Special populations:
• Glucose 6-phosphate dehydrogenase deficiency: Use with caution in patients with glucose 6-phosphate dehydrogenase deficiency.
• Pediatrics: Fevers may occur in ~30% of children and may persist for the duration of therapy.
Dosage form specific issues:
• Peanut oil: Product contains peanut oil; use with caution in patients with peanut allergy; medication for the treatment of hypersensitivity reactions should be available for immediate use.
Other warnings/precautions:
• Administration: Administer all injections deep I.M. at different sites.
Adverse Reactions
Frequency not always defined.
Cardiovascular: Chest pain, hypertension (dose related), tachycardia (dose related)
Central nervous system: Anxiety, fever (children ~30%), headache, nervousness
Dermatologic: Abscess
Gastrointestinal: Abdominal pain, burning sensation (lips, mouth, throat), nausea, salivation, throat irritation/pain, vomiting
Genitourinary: Burning sensation (penis)
Hematologic: Leukopenia (polymorphonuclear)
Local: Injection site pain
Neuromuscular & skeletal: Paresthesias (hand), weakness
Ocular: Blepharospasm, conjunctivitis, lacrimation
Renal: Acute renal insufficiency
Respiratory: Rhinorrhea, throat constriction
Miscellaneous: Diaphoresis
Drug Interactions
Iron salts: Dimercaprol may form a toxic complex with iron salts; avoid concurrent use.
Storage
Store at 20°C to 25°C (68°F to 77°F).
Mechanism of Action
Sulfhydryl group combines with ions of various heavy metals to form relatively stable, nontoxic, soluble chelates which are excreted in urine
Pharmacodynamics/Kinetics
Distribution: To all tissues including the brain
Metabolism: Rapidly hepatic to inactive metabolites
Time to peak, serum: 0.5-1 hour
Excretion: Urine
Dosage
Note: Premedication with an antihistamine is recommended.
Children and Adults: Deep I.M.:
Mild arsenic or gold poisoning: 2.5 mg/kg every 6 hours for 2 days, then every 12 hours for 1 day, followed by once daily for 10 days
Severe arsenic or gold poisoning: 3 mg/kg every 4 hours for 2 days, then every 6 hours for 1 day, followed every 12 hours for 10 days
Mercury poisoning: 5 mg/kg initially, followed by 2.5 mg/kg 1-2 times/day for 10 days
Lead poisoning:
Acute encephalopathy or blood lead levels >70 mcg/dL (in conjunction with calcium EDTA): 4 mg/kg loading dose, followed by 4 mg/kg every 4 hours for 2-7 days (calcium EDTA is not administered with the loading dose; begin calcium EDTA with the second dose)
Mild (in conjunction with calcium EDTA): 4 mg/kg/dose loading dose, followed by 3 mg/kg/dose every 4 hours for 2-7 days (calcium EDTA is not administered with the loading dose; begin calcium EDTA with the second dose)
Administration: I.M.
Administer all injections deep I.M. at different sites. Keep urine alkaline to protect renal function.
Monitoring Parameters
Renal function, urine pH, infusion-related reactions
Test Interactions
Iodine 131I thyroidal uptake values may be decreased
Dental Health: Effects on Dental Treatment
No significant effects or complications reported
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Mental Health: Effects on Mental Status
May cause nervousness
Mental Health: Effects on Psychiatric Treatment
May produce neutropenia; use caution with clozapine and carbamazepine
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Injection, oil:
BAL in Oil®: 100 mg/mL (3 mL) [contains benzyl benzoate and peanut oil]
References
Cantilena LR Jr and Klaassen CD, “The Effect of Chelating Agents on the Excretion of Endogenous Metals,” Toxicol Appl Pharmacol, 1982, 63(3):344-50.
Kosnett MJ, “Unanswered Questions in Metal Chelation,” J Toxicol Clin Toxicol, 1992, 30(4):529-47.
“Lead Exposure in Children: Prevention, Detection, and Management. American Academy of Pediatrics Committee on Environmental Health,” Pediatrics, 2005, 116(4):1036-46.
“Treatment Guidelines for Lead Exposure in Children. American Academy of Pediatrics Committee on Drugs,” Pediatrics, 1995, 96(1 Pt 1):155-60.
International Brand Names
Lexi-Comp.com
Last full review/revision April 2008
Content last modified April 2008
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