succimer

Absorption: Rapidly but variably absorbed following oral administration.

Distribution: Unknown.

Metabolism/Excretion: Extensively metabolized; 10% excreted unchanged by the kidneys.

Half-Life: 2 days.

Time/Action Profile ⬆ ⬇

ROUTE	ONSET	PEAK	DURATION
PO	within 2 hr	2–4 hr	8–12 hr

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Lactation: Lactation.

Use Cautiously in:

Renal failure (chelates are not dialyzable);
OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk;
Pedi: Children <1 yr (safety and effectiveness not established); ↑ risk of bradyarrhythmias in children; children with skeletal muscle myopathy (more prone to rare, but serious, adverse reactions) ;
Geri: Use lower doses in older adults to adjust for ↓ renal, hepatic and cardiac function.

Adv. Reactions/Side Effects ⬆ ⬇

CV: arrhythmias

Derm: mucocutaneous eruptions, pruritus, rash

EENT: otitis media, watery eyes, cloudy film in eye, plugged ears

GI: nausea, vomiting, elevated liver function tests, abdominal cramps, anorexia, diarrhea, hemorrhoidal symptoms, metallic taste

GU: oliguria, proteinuria, voiding difficulty

Hemat: eosinophilia, thrombocytosis

MS: leg pain, back, rib, flank pain

Neuro: drowsiness, dizziness, headache, paresthesia, sensorimotor neuropathy

Resp: cough, nasal congestion, rhinorrhea, sore throat

Misc: chills, fever, flu-like syndrome, HYPERSENSITIVITY REACTIONS (INCLUDING ANGIOEDEMA AND URTICARIA), moniliasis

Interactions ⬆ ⬇

Drug-drug:

Not recommended for use with other chelating agents.

Route/Dosage ⬆ ⬇

PO (Adults and Children ≥1 yr): 10 mg/kg (350 mg/m²) every 8 hr for 5 days, then ↓ to 10 mg/kg (350 mg/m²) every 12 hr for 2 more wk. Repeated courses should follow a 2-wk rest period.

Availability ⬆ ⬇

Capsules: 100 mg

Assessment ⬆ ⬇

Assess patient and family members for evidence of lead poisoning prior to and frequently during therapy. Monitor for signs and symptoms of acute lead poisoning (metallic taste, colicky abdominal pain, vomiting, diarrhea, oliguria, coma) and of chronic poisoning (anorexia, a blue-black line along the gums, intermittent vomiting, paresthesia, encephalopathy, seizures, coma).
Monitor strict intake and output and daily weight. Notify health care professional of any discrepancies. Ensure adequate hydration during succimer therapy.
Monitor neurologic status closely (level of consciousness, pupil response, movement). Notify health care professional immediately of any changes.
Monitor patient for signs of allergic or other mucocutaneous reactions, especially during repeated courses of succimer therapy.

Lab Test Considerations:

Monitor blood and urine lead levels prior to and periodically during therapy. After therapy, monitor patients for rebound of blood levels at least once weekly until stable. Succimer is indicated for treatment of blood lead levels of >45 mcg/dL.
- May cause elevated serum transaminases, alkaline phosphatase, and cholesterol; monitor prior to and at least weekly during therapy.
- May interfere with serum and urine lab tests.

Implementation ⬆ ⬇

Coadministration of succimer with other chelation agents is not recommended. Patients who have received ethylenediamine tetraacetic acid (EDTA) or may receive subsequent therapy with succimer after 4 wk.
- Course of treatment lasts 19 days. Doses are administered every 8 hr for 5 days and then every 12 hr for 14 days. Unless blood levels indicate prompt treatment is needed, a minimum of 2 wk between courses is recommended.
PO: If patient is unable to swallow the capsule, open capsule and sprinkle medicated beads on a small amount of soft food or place in a spoon and follow with a fruit drink.

Patient/Family Teaching ⬆ ⬇

Discuss need for follow-up appointments to monitor lead levels. Additional treatments may be necessary.
Instruct patient to drink adequate fluids during therapy.
Advise patient to notify health care professional if rash occurs.
Consult public health department regarding potential sources of lead poisoning in the home, workplace, and recreational areas. Chelation therapy cannot be used as prophylaxis for lead poisoning.
Rep: May be teratogenic. Advise females of reproductive potential to use effective contraception and avoid breastfeeding during therapy. Advise patient to notify health care professional promptly if pregnancy is suspected or if breastfeeding.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇