AHFS Class:
- Heavy Metal Antagonists 64:00
Generic Name(s):
Succimer is a heavy metal antagonist that chelates lead.1,2,3,4
Lead Poisoning
Succimer is used in the treatment of lead poisoning in children whose blood lead concentrations are greater than 45 mcg/dL,1,2 and the drug is designated an orphan drug by the US Food and Drug Administration (FDA) for use in this condition.9 Treatment with succimer should be accompanied by identification and removal of the source of lead exposure.1,2 Succimer should not be used prophylactically for the prevention of lead poisoning in a lead-containing environment.1,2 The US Centers for Disease Control and Prevention (CDC) currently states that while succimer appears to be an effective oral chelating agent with a high selectivity for lead and a low risk for chelating essential trace metals, further study and experience are needed to more fully elucidate the role of the drug in the treatment of lead poisoning.4
Pending further accumulation of data, CDC currently considers oral succimer an alternative to generally preferred parenteral chelation therapy for patients with blood lead concentrations exceeding 45 mcg/dL.4 However, the American Academy of Pediatrics (AAP) currently states that patients with blood lead concentrations greater than 70 mcg/dL or with clinical symptoms suggesting lead encephalopathy require inpatient therapy with the most effective parenteral chelating agents available,5 and most experts recommend combined therapy with parenteral edetate calcium disodium and dimercaprol in the management of such patients.4,5,8 CDC states that the decision to treat patients with blood lead concentrations of 70 mcg/dL or higher using succimer rather than parenteral chelation therapy should be made with the understanding that experience with succimer in such patients is limited.4 The manufacturer states that there currently are no data on the efficacy of succimer for the treatment of lead encephalopathy in children, although several adults with this condition have been treated successfully with the drug.1,2
The AAP currently recommends therapy with oral succimer in patients with blood lead concentrations of 45-70 mcg/dL who do not have symptoms of lead encephalopathy; alternatively, parenteral therapy with edetate calcium disodium alone is recommended.5 Children may need to be hospitalized during initiation of such therapy to allow monitoring for adverse effects and institution of environmental lead abatement procedures.5
The AAP states that therapy with oral succimer also may be used for retreatment of patients who have residual lead concentrations between 45-70 mcg/dL following initial treatment for severe lead poisoning (e.g., with edetate calcium disodium and dimercaprol).5 Because of the potential for adverse effects (e.g., anemia, neutropenia), patient noncompliance with therapy, and/or persistence of lead exposure during outpatient chelation therapy, the AAP recommends that oral chelation therapy be initiated under close medical supervision (e.g., inpatient therapy).5,6 For additional information on the treatment of lead poisoning, see Uses in Edetate Calcium Disodium 64:00.
The manufacturer states that efficacy of succimer in the treatment of other heavy metal poisonings has not been established by controlled studies, although the drug has increased urinary excretion of the metals and produced varying degrees of symptomatic improvement in a limited number of patients with mercury or arsenic poisoning.1,2 Succimer is designated an orphan drug by FDA for the treatment of mercury intoxication.9
Administration 
Succimer is administered orally.1,2 For young children who are unable to swallow the commercially available capsules, the contents of the capsules may be sprinkled on soft food just prior to administration or they may be placed on a spoon for administration and taken with fruit juice (to mask the characteristic sulfur odor).1,2
Dosage
For the treatment of lead poisoning in children, the usual initial succimer dosage is 10 mg/kg or 350 mg/m2 every 8 hours for 5 days.1,2 The manufacturer states that initiation of succimer therapy with higher dosages currently is not recommended.1,2 After the initial 5 days of therapy, succimer dosage should be reduced to 10 mg/kg or 350 mg/m2 every 12 hours for an additional 2 weeks of therapy.1,2 Depending on the blood lead concentration, additional courses of therapy with succimer may be necessary.1,2 Intervals of not less than 2 weeks are recommended between courses of succimer therapy unless blood lead concentrations require more prompt drug therapy.1,2 Patients who have received edetate calcium disodium (calcium EDTA) therapy, with or without dimercaprol, may receive succimer after an interval of 4 weeks;1,2 concomitant administration of succimer with edetate calcium disodium (with or without dimercaprol) currently is not recommended since the safety and efficacy of such combined therapy are not known.1,2
Description
Succimer, a dimercaptosuccinic acid, is a chelating agent.1,2,3 The drug is structurally related to dimercaprol.1,2
Additional Information
The American Society of Health-System Pharmacists, Inc. represents that the information provided in the accompanying monograph was formulated with a reasonable standard of care, and in conformity with professional standards in the field. Readers are advised that decisions regarding use of drugs are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and that the information contained in the monograph is provided for informational purposes only. The manufacturer's labeling should be consulted for more detailed information. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information contained in the monograph is not a substitute for medical care.
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.
Succimer
Routes | Dosage Forms | Strengths | Brand Names | Manufacturer |
|---|
Oral | Capsules | 100 mg | Chemet® (with povidone) | Sanofi-Aventis |
AHFS® Drug Information. © Copyright, 1959-2024, Selected Revisions June 10, 2024. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, MD 20814.
1. McNeil Consumer Products Company. Chemet® (succimer) capsules prescribing information. Fort Washington, PA: 1991 Feb.
2. McNeil Consumer Products Company. A summary of pharmacological and clinical data: Chemet® (succimer). Fort Washington, PA: 1991.
3. McNeil, Fort Washington, PA: Personal communication.
4. US Department of Health and Human Services. Preventing lead poisoning in young children: a statement by the Centers for Disease Control October 1991. Atlanta, GA: Centers for Disease Control, Center for Environmental Health.
5. Committee on Drugs, American Academy of Pediatrics. Treatment guidelines for lead exposure in children. Pediatrics . 1995; 96:155-60. [PubMed 7596706]
6. Committee on Environmental Health, American Academy of Pediatrics. Lead poisoning: from screening to primary prevention. Pediatrics . 1993; 92:176-83. [PubMed 8516071]
7. Mann KV, Travers JD. Succimer, an oral lead chelator. Clin Pharm . 1991; 10:914-22. [PubMed 1663439]
8. Piomelli S, Rosen JF, Chisolm JJ Jr et al. Management of childhood lead poisoning. J Pediatr . 1984; 105:523-32. [PubMed 6481529]
9. Food and Drug Administration. Orphan designations pursuant to Section 526 of the Federal Food and Cosmetic Act as amended by the Orphan Drug Act (P.L. 97-414), to June 28, 1996. Rockville, MD; 1996 Jul. [Web]