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Pronunciation
(SUKS si mer)
U.S. Brand Names
Index Terms
Generic Available
No
Canadian Brand Names
Pharmacologic Category
Use
Treatment of lead poisoning in children with serum lead levels >45 mcg/dL
Use: Unlabeled/Investigational
Treatment of lead poisoning in symptomatic adults
Pregnancy Risk Factor
C
Lactation
Excretion in breast milk unknown/not recommended
Contraindications
Hypersensitivity to succimer or any component of the formulation
Warnings/Precautions
Disease-related concerns:
• Lead poisoning: Investigate, identify, and remove sources of lead exposure prior to treatment. Succimer is not used to prevent lead poisoning. Primary care providers should consult experts in chemotherapy of lead toxicity before using chelation drug therapy.
• Encephalopathy: Succimer does not cross blood brain barrier and should not be used to treat encephalopathy associated with lead toxicity.
• Hepatic impairment: Use with caution in patients with hepatic impairment; monitor serum transaminase levels closely.
• Renal impairment: Use with caution in patients with renal impairment on hemodialysis as lead chelates are not dialyzable.
Other warnings/precautions:
• Hydration: Adequate hydration should be maintained during therapy.
• Rebounding serum lead levels: May occur after treatment as lead is released from storage sites into blood. Severity of rebound may guide intensity of future monitoring.
Adverse Reactions
1% to 10%:
Cardiovascular: Arrhythmia (adults 2%)
Central nervous system: Chills, dizziness, drowsiness, fatigue, fever, headache
Dermatologic: Rash (4%), pruritus
Endocrine & metabolic: Cholesterol increased
Gastrointestinal: Abdominal cramps, appetite decreased, diarrhea, hemorrhoid symptoms, metallic taste, mucosal irritation, nausea, sore throat, stomach pain, vomiting
Genitourinary: Proteinuria (adults), urine output decreased (adults)
Hepatic: ALT/AST (mildly increased, 6% to 10%), alkaline phosphatase increased
Neuromuscular & skeletal: Back pain, leg pain (adults), neuropathy, paresthesia
Otic: Otitis media
Respiratory: Cough, nasal congestion, rhinorrhea
Miscellaneous: Flu-like syndrome, moniliasis
<1%, postmarketing, and/or case reports: Allergic reactions (especially with retreatment), neutropenia (causal relationship not established)
Mechanism of Action
Succimer is an analog of dimercaprol. It forms water soluble chelates with heavy metals which are subsequently excreted renally. Succimer binds heavy metals; however, the chemical form of these chelates is not known.
Pharmacodynamics/Kinetics
Absorption: Rapid but incomplete
Metabolism: Rapidly and extensively to mixed succimer cysteine disulfides
Half-life elimination: 2 days
Time to peak, serum: ?1-2 hours
Excretion: Urine (?25%) with peak urinary excretion between 2-4 hours (90% as mixed succimer-cysteine disulfide conjugates, 10% as unchanged drug); feces (as unabsorbed drug)
Dosage
Oral:
Children: Oral: 10 mg/kg/dose (or 350 mg/m2/dose) every 8 hours for 5 days followed by 10 mg/kg/dose (or 350 mg/m2/dose) every 12 hours for 14 days
Adults (unlabeled use): 10 mg/kg/dose (or 350 mg/m2/dose) every 8 hours for 5 days, followed by 10 mg/kg/dose (or 350 mg/m2/dose) every 12 hours for 14 days
Note: Treatment courses may be repeated, but 2-week intervals between courses is generally recommended.
Dosing adjustment in renal/hepatic impairment: Administer with caution and monitor closely
Administration: Oral
Capsule can be separated and contents sprinkled on a small amount of soft food, or the contents placed on a spoon and administered followed by fruit drink.
Monitoring Parameters
Blood lead levels (baseline, after treatment to assess degree of rebound); serum aminotransferase, CBC with differential, platelets (baseline, and weekly during treatment)
Test Interactions
False-positive ketones (U) using nitroprusside methods, falsely decreased serum CPK; falsely decreased uric acid measurement
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 drowsiness or dizziness
Mental Health: Effects on Psychiatric Treatment
None reported
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Capsule:
Chemet®:100 mg
References
Dart RC, Hurlburt KM, Maiorino RM, et al, “Pharmacokinetics of Meso-2,3-Dimercaptosuccinic Acid in Patients With Lead Poisoning and in Healthy Adults,” J Pediatr, 1994, 125(2):309-16.
Fournier L, Thomas G, Garnier R, et al, “2,3-Dimercaptosuccinic Acid Treatment of Heavy Metal Poisoning in Humans,” Med Toxicol Adverse Drug Exp, 1988, 3(6):499-504.
Glotzer DE, “The Current Role of 2,3 Dimercaptosuccinic Acid (DMSA) in Management of Childhood Lead Poisoning,” Drug Saf, 1993, 9(2):85-92.
Gracia RC and Snodgrass WR, “Lead Toxicity and Chelation Therapy,” Am J Health Syst Pharm, 2007, 64(1):45-53.
Graziano JH, Lolacono NJ, Moulton T, et al, “Controlled Study of Meso-2,3-Dimercaptosuccinic Acid for the Management of Childhood Lead Intoxication,” J Pediatr, 1992, 120(1):133-9.
“Lead Exposure in Children: Prevention, Detection, and Management. American Academy of Pediatrics Committee on Environmental Health,” Pediatrics, 2005, 116(4):1036-46.
Mann KV and Travers JD, “Succimer, An Oral Lead Chelator,” Clin Pharm, 1991, 10(12):914-22.
Marcus S, Okose P, Jennis T, et al, “Untoward Effects of Oral Dimercaptosuccinic Acid in the Treatment for Lead Poisoning,” Vet Hum Toxicol, 1991, 33:376.
Staudinger KC and Roth VS, “Occupational Lead Poisoning,” Am Fam Physician, 1998, 57(4):719-26.
“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 January 2008
Content last modified January 2008
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