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Dimercaprol Drug Information Provided by Lexi-Comp

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This information has been developed and provided by an independent third-party source. Merck & Co., Inc. does not endorse and is not responsible for the accuracy of the content, or for practices or standards of non-Merck sources.

Pronunciation

(dye mer KAP role)

U.S. Brand Names

  • BAL in Oil®

Index Terms

  • BAL
  • British Anti-Lewisite
  • Dithioglycerol

Generic Available

No

Pharmacologic Category

  • Antidote

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

  • B.A.L. (DE, FR, IT)
  • BAL (IE, IN)
  • BAL In Oil (GR, MY)
  • Dicaptol (HU)
  • DMPS-Heyl (NO)
  • Sulfactin (PL)
  • Unithiol (PL)

Lexi-Comp.com

Last full review/revision April 2008

Content last modified April 2008

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