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dimercaprol (BAL, British anti-Lewisite, dithioglycerol, Sulfactin, Dimersol, Antoxol, Panobal)

Tradename: BAL in oil. Indications: 1) heavy metal poisonings: a) arsenic b) mercury c) gold 2) adjunctive treatment in lead poisoning 3) adjunctive treatment in Wilson's disease Contraindications: Caution: 1) give all injections deep IM 2) urinary alkalinization recommended to protect kidney 3) use with caution in patients with oliguria Dosage: 1) lead toxicity - 4 mg/kg, then 3-4 mg/kg every 4 hours for 5-7 days (4 mg/kg for severe lead toxicity) - 3 mg/kg every 4 hours for 2 days, then QID on day 3, then BID for 10 days [3] - alkalinization of the urine is necessary 2) mercury poisoning - 5 mg/kg, then 2.5 mg/kg QD-BID for 10 days, or - 3-5 mg/kg every 4 hours for 2 days, then QID on day 3, then BID for 10 days 3) arsenic & gold poisoning - 3 mg/kg every 4 hours for 2 days, then QID on day 3, then BID for 10 days Injection: 100 mg/mL (3 mL). Pharmacokinetics: 1) peak concentrations are obtained within 30 minutes of IM dosing 2) distributes mainly ito intracellular space of tissues, including brain, kidney & liver 3) inactivated by the liver 4) excreted in the urine Adverse effects: 1) common (> 10%) - hypertension, tachycardia, convulsions 2) less common (1-10%) - nausea/vomiting 3) uncommon (< 1%) - nervousness, anxiety, fever, headache, neutropenia (transient), pain at injection site, blepharospasm, nephrotoxicity, salivation, mucosal "burning" (lips, mouth, throat, eyes, penis) 4) other - breath odor - hemolysis in patients with G6PD deficiency Mechanism of action: - contains sulfhydryl groups that bind heavy metals

Related

arsenic poisoning glucose-6-phosphate 1-dehydrogenase (G6PD) lead poisoning (plumbism)

General

alcohol chelating agent thiol; sulhydryl compound; mercaptan

Database Correlations

PUBCHEM cid=3080

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. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
  4. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
  5. Department of Veterans Affairs, VA National Formulary