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Dimercaprol

  •     Na me of product:  Dimercaprol      
  • Dosage  form: Injection (i.m.) 
  • Strength:  100 mg/2 mL
  • Pack size: 2 ampules            
  • Manufacturer: Samarth Life (Pvt) (India   )

      

Uses

  • acute poisoning by antimony, arsenic, bismuth, gold, mercury, possibly thallium; adjunct (with calcium disodium edetate) in lead poisoning

Contraindications

  • selenium, and cadmium poisoning, organic mercury; severe hepatic impairment (unless due to arsenic poisoning)

Precautions

  • hypertension; renal impairment (discontinue or use with extreme caution if impairment develops during treatment-any abnormal reaction such as hyperpyrexia should be assessed; the elderly; pregnancy - and breastfeeding)

Pregnancy catergory: C

Interactions

  • Concomitant use of dimercaprol and iron should be avoided due to the potential increased risk of nephrotoxicity

Administration

  • Deep intramuscular injection

Dose

  • Arsenic and Gold poisoning: ADULT and CHILD,

Mild to moderate toxicity: 2.5 mg/kg 4 times daily for 2 days then 2 times on 3rd day, then OD for 10 day

Severe toxicity: 3 mg/kg every 4 hours for 2 days then 4 times on 3rd day and twice daily for 10 days or until recovery

  • Lead poisoning:

Mild to moderate toxicity: ADULT, 300 - 450 mg/m2/day or 50–75 mg/m2 IM q 4 h or 4 mg/kg followed by 3 mg/kg every 4 hours for 3 - 5 days; CHILD, 300 - 450 mg/m2/day or 50 - 75 mg/m2 IM every 4 hours for 3 - 5 days 

Lead encephalopathy: ADULT, 450 mg/m2/day or 75 mg/m2 IM every 4 hours or 4 mg/kg q 4 h for 5 days after the 1st dose combined therapy with CaNa2 EDTA; CHILD, 450 mg/m2/day or 75 mg/m2 IM every 4 hours for 5 days

  • Mercury (inorganic) poisoning: ADULT and CHILD, 5 mg/kg IM followed by 2.5 mg/kg IM every 12 - 24 hours for 10 days

Adverse effects

  • hypertension, tachycardia; malaise, nausea, vomiting, abdominal pain, salivation, lacrimation, sweating, burning sensation in the mouth, throat, and eyes; feeling of constriction in the throat and chest; headache, muscle spasms, tingling of the extremities; fever in children; local pain and abscess at injection site

Reference

  • Dimercaprol. In: IBM Micromedex® DRUGDEX® (electronic version). IBM Watson Health, Greenwood Village, Colorado, USA. Available at: https://www.micromedexsolutions.com/ (cited: Mar/1/2022).
  • Kosnet MJ. BAL (DIMERCAPROL). In: Olson KR, Anderson IB, Benowitz NL, Blanc PD, Clark RF, Kearney TE, et al., editors. Poisoning & Drug Overdose. 7th ed. New York: McGraw-Hill Education; 2018. p. 514-6.
  • Howland MA. Dimercaprol (British Anti-Lewisite or BAL). In: Lewis S. Nelson, Howland MA, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS, editors. Goldfrank’s Toxicologic Emergencies. 11th ed. New York: McGraw-Hill Education; 2019. p. 1251-1254.
  • World Health Organization. WHO guideline for clinical management of exposure to lead [Internet]. 2021 [cited 2022 Jan 16]. Available from: https://www.who.int/publications/i/item/9789240036888.