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succimer; 2,3-dimercaptosuccinic acid (DMSA, Chemet)

Tradename: Chemet. (also 99Tc succimer) Indications: - lead poisoning in children with blood levels > 45 ug//dL - treatment of arsenic poisoning [4] - treatment of mercury poisoning [4] Contraindications: - treatment of iron overload [4] Caution: 1) renal insufficiency or hepatic insufficiency 2) maintain adequate hydration Dosage: 1) 10 ug/kg PO every 8 hours for 1st 5 days, then 2) 10 ug/kg PO every 12 for next 14 days Capsule: 100 mg. Adverse effects: 1) common (> 10%) - nausea/vomiting, diarrhea, appetite loss, hemorrhoidal symptoms, metallic taste, back pain, fever 2) less common (1-10%) - elevated liver function tests (AST, ALT, ALP)*, elevated serum cholesterol, influenza-like symptoms, drowsiness, dizziness, rash, sore throat, nasal congestion, cough 3) uncommon (< 1%) - cardiac arrhythmias * serum ALT, serum AST, serum alkaline phosphatase Drug interactions: - not recommended for concurrent use with: a) edetate calcium disodium b) penicillamine

General

chelating agent

Database Correlations

PUBCHEM correlations

References

  1. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  2. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1168
  3. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  4. NEJM Knowledge+ Question of the Week. Aug 21, 2018 https://knowledgeplus.nejm.org/question-of-week/4149/