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Indications and Dosage
Intramuscular
Heavy metal poisoning Adult: 400-800 mg on the 1st day followed by 200-400 mg on the 2nd and 3rd day, then 100-200 mg on the 4th and subsequent days, all in divided doses. Intramuscular Adjunct in lead poisoning Adult: In conjunction w/ sodium calcium edetate: Initially, 4 mg/kg followed by 3-4 mg/kg at 4-hrly intervals. Maintenance: 2-7 days.
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Hepatic Impairment
Contraindicated.
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Contraindications
Hepatic impairment. Concomitant use w/ Fe, cadmium, uranium or selenium.
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Special Precautions
Patient w/ HTN, oliguria, G6PD deficiency, peanut allergy. Renal impairment. Pregnancy and lactation.
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Adverse Reactions
Tachycardia, HTN, nausea, vomiting, headache, burning sensation of the lips, mouth, throat, eyes and penis, salivation, lacrimation, tingling of the extremities, sensation of throat and chest constriction, sweating, conjunctivitis, muscle pains and spasm, rhinorrhoea, anxiety, abdominal pain, weakness, pain at the inj site, sterile abscess.
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IM/Parenteral: C
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Monitoring Parameters
Monitor urine pH, renal function, infusion-related reactions, blood levels, Hb or haematocrit, Fe status.
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Overdosage
Symptoms: Nausea, vomiting, malaise, lacrimation, salivation; burning sensation of lips, throat, mouth and eyes w/ headache; sense of throat and chest constriction; increased BP. Management: Admin SC diphenhydramine 50 mg or ephedrine 30 mg, or oral ephedrine 30-60 mg.
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Drug Interactions
Potentially Fatal: May form toxic complexes w/ Fe supplements, cadmium, selenium, uranium.
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Lab Interference
Interferes w/ normal accumulation of iodine by the thyroid. Decreased iodine I 131 thyroidal uptake values.
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Action
Description: Dimercaprol chelates heavy metals e.g. gold, arsenic, mercury by competing w/ endogenous sulfhydryl groups on enzymes. This chelation prevents or reverses any inhibition of the sulfhydryl enzymes by the metal and forms a complex readily secreted in the kidneys.
Pharmacokinetics: Absorption: Rapidly absorbed. Time to peak plasma concentration: 30-60 min. Distribution: Widely distributed to all tissues including the brain, w/ the highest concentrations in the liver and kidneys. Metabolism: Undergoes rapid hepatic metabolism and converted to inactive metabolites. Excretion: Via urine and bile. Essentially complete elimination w/in 4 hr of a single dose. |
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Chemical Structure
 Source: National Center for Biotechnology Information. PubChem Database. Dimercaprol, CID=3080, https://pubchem.ncbi.nlm.nih.gov/compound/Dimercaprol (accessed on Jan. 21, 2020) |
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Storage
Store between 20-25°C.
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MIMS Class
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ATC Classification
V03AB09 - dimercaprol ; Belongs to the class of antidotes. Used in the management of heavy metals poisoning.
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References
Anon. Dimercaprol. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 19/01/2016. BAL – Dimercaprol Injection (Akorn, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 19/01/2016. Buckingham R (ed). Dimercaprol. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 19/01/2016. McEvoy GK, Snow EK, Miller J et al (eds). Dimercaprol. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 19/01/2016.
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