Dimercaprol
Indications and Usage
- Dimercaprol effectively chelates radioactive and stable nuclides of mercury, lead, arsenic, gold, and polonium-210.
- Dimercaprol is an FDA-approved treatment for arsenic, gold, and mercury poisoning. It is indicated in acute lead poisoning when used concomitantly with EDTA.
- Dimercaprol is quite toxic, with about 50% of patients given 6 mg/kg IM developing reactions. These include systolic and diastolic hypertension, tachycardia, nausea, vomiting, chest pain, headache, and sterile abscess at the injection site.
- Dimercaprol is effective for use in acute poisoning by mercury salts if therapy is begun within 1 to 2 hours following ingestion. Dimercaprol is of unknown value in poisoning caused by other heavy metals such as antimony or bismuth.
- IM Dosing
- 2.5 mg/kg QID x 2 days (days 1 & 2)
- then bid for 1 day (day 3)
- then qd (days 4-10)
- It is available as 300 mg/vial for deep IM use (suspension in peanut oil).
FDA Product Safety Info
- Not FDA approved for this indication/off-label use
- Adverse events have been reported following use of dimercaprol.
- Use of dimercaprol has been considered in only the most severe cases of polonium poisoning due to its potential toxicity.
- Dimercaprol is contraindicated in most instances of hepatic insufficiency.
- Dimercaprol should be discontinued or used with extreme caution if acute renal insufficiency develops during therapy.
Drug Label
- BAL In Oil (dimercaprol) Injection (DailyMed)
References
- Management of Persons Contaminated with Radionuclides: Handbook (NCRP Report No. 161, Vol. I), National Council on Radiation Protection and Measurements, Bethesda, MD, 2008, Decorporation Therapy by Drug (p. 189) and Table 12.5 (p. 190). [Note: NCRP 161 supersedes NCRP 65.]