Adult Dosing

Reduction of blood levels and depot stores of lead in lead poisoning (acute and chronic) and lead encephalopathy

Asymptomatic blood lead 20-70 mcg/dL

• 1,000 mg/m ²/day IV over 8-12 hours or IM in divided doses every 8-12 hours
• Treat for 5 days, stop 2 to 4 days and repeat course if needed, not to exceed recommended daily dosage

Lead nephropathy

• 500 mg/m ² IV/IM q24hr x 5 days for patients with serum creatinine levels of 2-3 mg/dl, every 48 hours for 3 doses for patients with creatinine levels of 3-4 mg/dl, and once weekly for patients with creatinine levels above 4 mg/dl

Symptoms of lead encephalopathy and/or blood lead level >70 mcg/dL

• Use with dimercaprol (BAL) x 5 days

Pediatric Dosing

Asymptomatic blood lead 20-70 mcg/dL

• 1,000 mg/m ²/day IV over 8-12 hours or IM in divided doses every 8-12 hours
• Treat for 5 days, stop 2 to 4 days and repeat course if needed, not to exceed recommended daily dosage

Lead nephropathy

• 500 mg/m ² IV/IM q24hr x 5 days for patients with serum creatinine levels of 2-3 mg/dl, every 48 hours for 3 doses for patients with creatinine levels of 3-4 mg/dl, and once weekly for patients with creatinine levels above 4 mg/dl

Symptoms of lead encephalopathy and/or blood lead level >70 mcg/dL

• Use with dimercaprol (BAL) x 5 days

[Outline]

• Adult Dosing
• Pediatric Dosing

• Reduction of blood levels and depot stores of lead in lead poisoning (acute and chronic) and lead encephalopathy

• Hypersensitivity to any of the ingredients of the product
• Periods of anuria
• Patients with active renal disease
• Hepatitis

• Edetate calcium disodium is capable of producing toxic effects, which can be fatal
• Lead encephalopathy is relatively rare in adults, but occurs more often in pediatric patients in whom it may be incipient and thus overlooked. The mortality rate in pediatric patients has been high
• Patients with lead encephalopathy and cerebral edema may experience a lethal increase in intracranial pressure following intravenous infusion. The intramuscular route is preferred for these patients
• Avoid rapid infusion, in cases where the intravenous route is necessary
• The dosage schedule should be followed and the recommended daily dose should not be exceeded

Renal Dose Adjustment

• Renal impairment: Contraindicated

Hepatic Dose Adjustment

• Hepatic impairment: Contraindicated

• Edetate calcium disodium is capable of producing toxic effects, which can be fatal [US Black box warning]
• Lead encephalopathy is relatively rare in adults, but occurs more often in pediatric patients in whom it may be incipient and thus overlooked. The mortality rate in pediatric patients has been high [US Black box warning]
• Patients with lead encephalopathy and cerebral edema may experience a lethal increase in intracranial pressure following intravenous infusion. The intramuscular route is preferred for these patients [US Black box warning]
• Avoid rapid infusion, in cases where the intravenous route is necessary [US Black box warning]
• The dosage schedule should be followed and the recommended daily dose should not be exceeded [US Black box warning]
• Urine flow must be monitored throughout therapy; Discontinue therapy as Calcium Disodium Versenate therapy if anuria or severe oliguria develops
• Edetate calcium disodium may produce the same renal damage as lead poisoning, such as proteinuria and microscopic hematuria
• Patients should be monitored for cardiac rhythm irregularities and other ECG changes during intravenous therapy
• Urinalysis and urine sediment, renal and hepatic function and serum electrolyte levels should be monitored before each course of therapy and then be monitored daily during therapy in severe cases

Pregnancy Category:B

Breastfeeding: It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when administered to a nursing woman.

• CNS: Tremors, headache, numbness, tingling
• GI: Cheilosis, nausea, vomiting, anorexia, excessive thirst
• CV: Hypotension, cardiac rhythm irregularities, thrombophlebitis
• HEMA: Transient bone marrow depression, anemia
• LAB TESTS: Mild increases in SGOT and SGPT
• METABOLIC: Zinc deficiency, hypercalcemia
• GU: Acute necrosis of proximal tubules, infrequent changes in distal tubules and glomeruli
• MISCELLANEOUS: Pain at intramuscular injection site, myalgia, hypersensitivity reactions, fever

• Chelating agent; forms chelates with divalent and trivalent metal to enhance elimination of metals, particulary lead
• Metabolism: Unknown
• Excretion: Primarily by the kidney, with about 50% excreted in one hour and over 95% within 24 hours
• Half-life: 20 to 60 minutes

US Trade Name(s)

• Calcium disodium versenate

US Availability

Calcium disodium versenate

• INJ: 200 mg/mL (2.5 mL vial)

Canadian Trade Name(s)

• N/A

Canadian Availability

• N/A

UK Trade Name(s)

• N/A

UK Availability

• N/A

Australian Trade Name(s)

• N/A

Australian Availability

• N/A

[Outline]

Emergency/Critical Care

Antidotes

Chelating Agents