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chelation therapy

Indications: 1) lead poisoning a) calcium EDTA - 35-75 mg/kg/day IV in divided BID/TID for 3-5 days - monitor renal & hepatic function during therapy b) dimercaprol (BAL in oil) - 3-4 mg/kg IM every 4 hours for 5-7 days - do not use in children allergic to peanuts or patients with G6PD deficiency c) D-penicillamine (Cuprimine) - 25-35 g/kg/day PO - do not use in patients allergic to penicillin - not FDA approved for plumbism d) succimer (DMSA) (Chemet) PO, for outpatient chelation - 3 weeks of therapy - 10 ug/kg PO every 8 hours for 1st 5 days - 10 ug/kg PO every 12 hours for next 14 days 2) iron poisoning - deferoxamine 10-15 mg/kg/hr IM or IV until serum iron < 250 ug/dL Contraindications: - of no benefit for coronary artery disease [2] - slight benefit for coronary artery disease [3] (many skeptics of study) - slight benefit for secondary pevention of myocardial infarction [4] (editor skeptical) Mechanism of action: - removes cations from circulation, Pb+2, Fe+2, Ca+2

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chelating agent

General

pharmacologic therapy

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1155, 1167-68
  2. Journal Watch 22(4):28, 2002 Knudtson ML et al. for the Program to Assess Alternative Treatment Strategies to Achieve Cardiac Health (PATCH) Investigators. Chelation therapy for ischemic heart disease: A randomized controlled trial. JAMA 2002 Jan 23/30; 287:481-6. PMID: 11798370
  3. Pollack A Much-Debated Treatment for Heart Disease Shows Slight Benefit in Clinical Trial New York Times. November 4, 2012 Report from the 2012 American Heart Association Meeting http://www.nytimes.com/2012/11/05/health/chelation-therapy-shows-slight-benefit-in-heart-disease-clinical-trial.html?_r=0
  4. Lamas GA Effect of Disodium EDTA Chelation Regimen on Cardiovascular Events in Patients With Previous Myocardial Infarction. The TACT Randomized Trial. JAMA. 2013;309(12):1241-1250 PMID: 23532240 http://jama.jamanetwork.com/article.aspx?articleid=1672238 - Nissen SE Concerns About Reliability in the Trial to Assess Chelation Therapy (TACT). JAMA. 2013;309(12):1293-1294 PMID: 23532246 http://jama.jamanetwork.com/article.aspx?articleid=1672219
  5. Learn More About Chelation Therapy and the Study http://www.nccam.nih.gov/chelation/chelationstudy.htm