Dimercaprol

Dimercaprol
Adult Indications & Dosage
Pediatric Indications & Dosage
Contraindications
Warnings & Precautions
Adverse Reactions
Drug Interactions
Use in Specific Populations
Administration & Monitoring
Overdosage
Pharmacology
Clinical Studies
How Supplied
Images
Patient Counseling Information
Precautions with Alcohol
Brand Names
Look-Alike Names

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Stefano Giannoni [2]

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Overview

Dimercaprol is {{{aOrAn}}} heavy metal chelator that is FDA approved for the treatment of arsenic, gold and mercury poisoning. It is indicated in acute lead poisoning when used concomitantly with Edetate Calcium Disodium Injection USP. Common adverse reactions include Blepharospasm, conjunctivitis, lacrimation, nasal discharge, tightness sensation in chest, limbs, jaw and abdomen, injection site pain, nausea, vomiting, headache, paresthesia, tremor.

Adult Indications and Dosage

FDA-Labeled Indications and Dosage (Adult)

Mild Arsenic or Gold Poisoning

• 2.5 mg/kg of body weight four times daily for two days.
• Two times on the third day.
• Only once daily thereafter for ten days.

Severe Arsenic or Gold Poisoning

• 3 mg/kg every four hours for two-days
• Four times on the third day
• Twice daily thereafter for ten days.

Mercury poisoning

• 5 mg/kg initially, followed by 2.5 mg/kg one or two times daily for ten days.

Acute Lead Encephalopathy

• 4 mg/kg body weight is given alone in the first dose
• Thereafter at four-hour intervals in combination with Edetate Calcium Disodium Injection USP administered at a separate site.
• For less severe poisoning the dose can be reduced to 3 mg/kg after the first dose.
• Treatment is maintained for two to seven days depending on clinical response. *Successful treatment depends on beginning injections at the earliest possible moment and on the use of adequate amounts at frequent intervals

Off-Label Use and Dosage (Adult)

Guideline-Supported Use

There is limited information regarding Off-Label Guideline-Supported Use of Dimercaprol in adult patients.

Non–Guideline-Supported Use

There is limited information regarding Off-Label Non–Guideline-Supported Use of Dimercaprol in adult patients.

Pediatric Indications and Dosage

FDA-Labeled Indications and Dosage (Pediatric)

Mild Arsenic or Gold Poisoning

• 2.5 mg/kg of body weight four times daily for two days.
• Two times on the third day.
• Only once daily thereafter for ten days.

Severe Arsenic or Gold Poisoning

• 3 mg/kg every four hours for two-days
• Four times on the third day
• Twice daily thereafter for ten days.

Mercury poisoning

• 5 mg/kg initially, followed by 2.5 mg/kg one or two times daily for ten days.

Acute Lead Encephalopathy

• 4 mg/kg body weight is given alone in the first dose
• Thereafter at four-hour intervals in combination with Edetate Calcium Disodium Injection USP administered at a separate site.
• For less severe poisoning the dose can be reduced to 3 mg/kg after the first dose.
• Treatment is maintained for two to seven days depending on clinical response. *Successful treatment depends on beginning injections at the earliest possible moment and on the use of adequate amounts at frequent intervals

Off-Label Use and Dosage (Pediatric)

Guideline-Supported Use

There is limited information regarding Off-Label Guideline-Supported Use of Dimercaprol in pediatric patients.

Non–Guideline-Supported Use

There is limited information regarding Off-Label Non–Guideline-Supported Use of Dimercaprol in pediatric patients.

Contraindications

• Dimercaprol (Dimercaprol Injection USP) is contraindicated in most instances of hepatic insufficiency with the exception of postarsenical jaundice.
• The drug should be discontinued or used only with extreme caution if acute renal insufficiency develops during therapy.

Warnings

• There may be local pain at the site of the injection.
• A reaction apparently peculiar to children is fever which may persist during therapy.
• It occurs in approximately 30% of children.
• A transient reduction of the percentage of polymorphonuclear leukocytes may also be observed.

Adverse Reactions

Clinical Trials Experience

Cardiovascular

• Rise in blood pressure accompanied by tachycardia.
• This rise is roughly proportional to the dose administered.

Doses larger than those recommended may cause other transitory signs and symptoms in approximate order of frequency as follows:

Gastrointestinal

• Nausea
• abdominal pain
• in some instance, vomiting

====Nervous System:

• Headache
• Tingling of the hands
• Burning sensation in the penis

Ophtalmology

• Conjunctivitis
• Lacrimation
• Blepharal spasm

Other

• Rhinorrhea
• Salivation
• Sweating of the forehead, hands and other area
• Occasional appearance of painful sterile abscesses.
• Burning sensation in the lips, mouth and throat
• A feeling of constriction, even pain, in the throat, chest, or hands

Many of the above symptoms are accompanied by a feeling of anxiety, weakness, and unrest and often are relieved by administration of antihistamine.

Postmarketing Experience

There is limited information regarding Dimercaprol Postmarketing Experience in the drug label.

Drug Interactions

There is limited information regarding Dimercaprol Drug Interactions in the drug label.

Use in Specific Populations

Pregnancy

Pregnancy Category (FDA): C Animal reproduction studies have not been conducted with dimercaprol. It is also not known whether dimercaprol can cause fetal harm when administered to a pregnant woman, or can affect reproduction capacity. dimercaprol should be given to a pregnant woman only if clearly needed.

It is not known whether this drug is excreted in human milk. However, because many drugs are excreted in human milk, caution should be exercised when dimercaprol is administered to a nursing woman.
Pregnancy Category (AUS): There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Dimercaprol in women who are pregnant.

Labor and Delivery

There is no FDA guidance on use of Dimercaprol during labor and delivery.

Nursing Mothers

There is no FDA guidance on the use of Dimercaprol in women who are nursing.

Pediatric Use

There is no FDA guidance on the use of Dimercaprol in pediatric settings.

Geriatic Use

There is no FDA guidance on the use of Dimercaprol in geriatric settings.

Gender

There is no FDA guidance on the use of Dimercaprol with respect to specific gender populations.

Race

There is no FDA guidance on the use of Dimercaprol with respect to specific racial populations.

Renal Impairment

There is no FDA guidance on the use of Dimercaprol in patients with renal impairment.

Hepatic Impairment

There is no FDA guidance on the use of Dimercaprol in patients with hepatic impairment.

Females of Reproductive Potential and Males

There is no FDA guidance on the use of Dimercaprol in women of reproductive potentials and males.

Immunocompromised Patients

There is no FDA guidance one the use of Dimercaprol in patients who are immunocompromised.

Administration and Monitoring

Administration

• Intramuscular

Monitoring

There is limited information regarding Dimercaprol Monitoring in the drug label.

IV Compatibility

There is limited information regarding the compatibility of Dimercaprol and IV administrations.

Overdosage

• Dosage exceeding 5 mg/kg will usually be followed by vomiting, convulsions and stupor, beginning within 30 minutes and subsiding within 6 hours following injection.

Pharmacology

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Dimercaprol

Names
IUPAC name 2,3-Disulfanylpropan-1-ol
Other names 2,3-Dimercaptopropanol British anti-Lewisite
Identifiers
CAS Number	59-52-9 Y 16495-08-2 (2R)-2-sulfanyl Y 16495-16-2 (2S)-2-sulfanyl Y
3D model (JSmol)	Interactive image
ChEMBL	ChEMBL1597 Y
ChemSpider	2971 Y 5342114 (2R)-2-sulfanyl Y 2496803 (2S)-2-sulfanyl Y
DrugBank	DB06782 Y
ECHA InfoCard
KEGG	D00167 Y
MeSH	Dimercaprol
PubChem CID	3080 6971262 (2R)-2-sulfanyl 3246063 (2S)-2-sulfanyl
UNII	0CPP32S55X Y
InChI InChI=1S/C3H8OS2/c4-1-3(6)2-5/h3-6H,1-2H2 Y Key: WQABCVAJNWAXTE-UHFFFAOYSA-N Y
SMILES OCC(S)CS
Properties
Chemical formula	C 3H 8S 2O
Molar mass	124.225 g mol-1
Hazards
Except where otherwise noted, data are given for materials in their standard state (at 25 °C [77 °F], 100 kPa).
Infobox references

Mechanism of Action

• The sulfhydryl groups of dimercaprol form complexes with certain heavy metals thus preventing or reversing the metallic binding of sulfhydryl-containing enzymes.
• The complex is excreted.
• The sustained presence of dimercaprol promotes continued excretion of the metallic poisons - arsenic, gold and mercury.
• It is also used in combination with Edetate Calcium Disodium Injection USP to promote the excretion of lead.

Structure

Pharmacodynamics

There is limited information regarding Dimercaprol Pharmacodynamics in the drug label.

Pharmacokinetics

There is limited information regarding Dimercaprol Pharmacokinetics in the drug label.

Nonclinical Toxicology

There is limited information regarding Dimercaprol Nonclinical Toxicology in the drug label.

Clinical Studies

There is limited information regarding Dimercaprol Clinical Studies in the drug label.

How Supplied

• 3 mL (100 mg/mL) ampules, box of 10 (NDC 17478-526-03).

Storage

• Store at 20° to 25°C (68° to 77°F)

Images

Drug Images

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Package and Label Display Panel

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Patient Counseling Information

There is limited information regarding Dimercaprol Patient Counseling Information in the drug label.

Precautions with Alcohol

Alcohol-Dimercaprol interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.

Brand Names

• Bal In Oil

Look-Alike Drug Names

There is limited information regarding Dimercaprol Look-Alike Drug Names in the drug label.

Drug Shortage Status

Price

References

The contents of this FDA label are provided by the National Library of Medicine.

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Dimercaprol

File:Dimercaprol.svg
Clinical data
ATC code	V03AB09 (WHO)
Identifiers
IUPAC name 2,3-Dimercaptopropanol
CAS Number	59-52-9
PubChem CID	3080
E number	{{#property:P628}}
ECHA InfoCard	{{#property:P2566}}
Chemical and physical data
Formula	C3H8OS2
Molar mass	124.227
3D model (JSmol)	Interactive image
SMILES OCC(S)CS

Template:Nfpa-float Dimercaprol (INN) or British anti-Lewisite (abbreviated BAL), is a compound developed by British biochemists at Oxford University during World War II. It was developed secretly as an antidote for Lewisite, the now-obsolete arsenic-based chemical warfare agent. Today, it is used medically in treatment of arsenic, mercury and lead, and other heavy metal poisoning. In addition, it is used for the treatment of Wilson's disease, a genetic disorder in which the body tends to retain copper.

Biochemical function

Heavy metals act by chemically reacting with adjacent sulfhydryl residues on metabolic enzymes, creating a chelate complex that inhibits the affected enzyme's activity. Dimercaprol competes with the sulfhydryl groups for binding the metal ion, which is then excreted in the urine.

Dimercaprol is itself toxic, with a narrow therapeutic range and a tendency to concentrate arsenic in some organs. Other drawbacks include the need to administer it by painful intramuscular injection.

BAL has been found to form stable chelates in vivo with many toxic metals including inorganic mercury, antimony, bismuth, cadmium, chromium, cobalt, gold, and nickel. However, it is not necessarily the treatment of choice for toxicity to these metals. BAL has been used as an adjunct in the treatment of the acute encephalopathy of lead toxicity. It is a potentially toxic drug, and its use may be accompanied by multiple side effects. Although treatment with BAL will increase the excretion of cadmium, there is a concomitant increase in renal cadmium concentration, so that its use in case of cadmium toxicity is to be avoided. It does, however, remove inorganic mercury from the kidneys; but is not useful in the treatment of alkylmercury or phenyl mercury toxicity. BAL also enhances the toxicity of selenium and tellurium, so it is not to be used to remove these metals from the body.

See also

• Chelation therapy

References

• British anti-Lewisite Molecule of the Month, University of Bristol School of Chemistry

• Casarett and Doull's Toxicology, the basic science of poisons