Adult Dosing

Mild arsenic or gold poisoning

• 2.5 mg/kg IM qid x 2 days; bid on third day; thereafter qd x 10 days

Severe arsenic or gold poisoning

• 3 mg/kg IM q4 hrs x 2 days; qid third day; then bid thereafter x 10 days

Mercury poisoning

• Start with 5 mg/kg IM; followed by 2.5 mg/kg IM qd-bid x 10 days

Acute lead encephalopathy

• Start with 4 mg/kg IM; thereafter at 4-hr intervals in combination with edetate calcium disodium injection USP administered at a separate site
• Reduce dose to 3 mg/kg after the first dose for less severe poisoning
• Maintain treatment for 2-7 days depending on clinical response

Note:

• For deep IM use only
• Begin injections at the earliest possible moment and use adequate amounts at frequent intervals
• Use other supportive measures in conjunction with therapy
• Prior to administration, inspect visually for presence of particulate matter and discoloration
• Ensure adequate alkaline urine production

Pediatric Dosing

Mild arsenic or gold poisoning

• 2.5 mg/kg IM qid x 2 days; bid on third day; thereafter qd x 10 days

Severe arsenic or gold poisoning

• 3 mg/kg IM q4 hrs x 2 days; qid third day; then bid thereafter x 10 days

Mercury poisoning

• Start with 5 mg/kg IM; followed by 2.5 mg/kg IM qd-bid x 10 days

Acute lead encephalopathy

• Start with 4 mg/kg IM; thereafter at 4-hr intervals in combination with edetate calcium disodium injection USP administered at a separate site
• Reduce dose to 3 mg/kg after the first dose for less severe poisoning
• Maintain treatment for 2-7 days depending on clinical response

Note:

• For deep IM use only
• Begin injections at the earliest possible moment and use adequate amounts at frequent intervals
• Use other supportive measures in conjunction with therapy
• Prior to administration, inspect visually for presence of particulate matter and discoloration
• Ensure adequate alkaline urine production

[Outline]

• Adult Dosing
• Pediatric Dosing

• Arsenic, gold and mercury poisoning
• Acute lead poisoning on concomitant use with edetate calcium disodium injection USP
• Acute poisoning by mercury salts if therapy is begun within 1 or 2 hrs following ingestion

• Hypersensitivity to any of the ingredients of the product
• Hepatic insufficiency with the exception of postarsenical jaundice
• Iron, cadmium, selenium, silver, uranium poisoning
• Alkyl (short-chain) mercury poisoning

• N/A

Renal Dose Adjustment

• Acute renal impairment: Use with extreme caution or discontinue

Hepatic Dose Adjustment

• Hepatic impairment: Contraindicated

• Local pain at the site of the injection have occurred; Fever may persist in children during course of therapy
• A transient reduction of the percentage of polymorphonuclear leukocytes have occurred
• Discontinue therapy or use only with extreme caution on occurrence of acute renal insufficiency during therapy
• Avoid administration of medicinal iron to patients undergoing therapy with the drug
• Allergic reactions may occur in patients having hypersensitivity to peanuts; provide appropriate medication and equipment necessary to treat allergic reactions
• Monitor creatinine at baseline, then periodically

Cautions: Use cautiously in

• Renal impairment
• G6PD deficiency
• Hypertension
• Hypersensitivity to peanuts

Pregnancy Category:C

Breastfeeding: Safety unknown; Unknown whether the drug is excreted in human milk. Manufacturer advises caution.

• HEMA: Neutropenia
• LOCAL: Injection site pain, painful sterile abscesses
• CV: Hypertension, tachycardia
• GI: Nausea, vomiting, burning oral sensation, salivation, abdominal pain
• CNS: Headache, anxiety, feeling of unrest
• MISC: Fever in children, weakness, a feeling of constriction or pain in the chest or hands
• MUSC: Blepharospasm
• GU: Burning sensation in the penis
• NEURO: Paresthesias, tingling sensation in the hands
• DERM: Diaphoresis
• EENT: Conjunctivitis, lacrimation, rhinorrhea, throat constriction or pain

• Heavy metal antagonist; forms complexes with heavy metals, prevents or reverses the metallic binding of sulfhydryl-containing enzymes and promotes excretion of the metallic poisons
• Metabolism: Unknown
• Excreted in urine and feces/bile
• Half life: Unknown

US Trade Name(s)

• Bal

US Availability

Bal

• INJ: 100 mg/mL (3 mL amp)

Canadian Trade Name(s)

• Bal

Canadian Availability

Bal

• INJ: 100 mg/mL (3 mL amp)

UK Trade Name(s)

• Only generic available

UK Availability

dimercaprol (generic)

• INJ: 5%

Australian Trade Name(s)

• N/A

Australian Availability

• N/A

[Outline]

Emergency/Critical Care

Antidotes