chelation therapy

^[1]^[2]^[3]^[4]^[5]

Indications

lead poisoning
- calcium EDTA
  - 35-75 mg/kg/day IV in divided BID/TID for 3-5 days
  - monitor renal & hepatic function during therapy
- dimercaprol (BAL in oil)
  - 3-4 mg/kg IM every 4 hours for 5-7 days
  - do not use in children allergic to peanuts or patients with G6PD deficiency
- D-penicillamine (Cuprimine)
  - 25-35 g/kg/day PO
  - do not use in patients allergic to penicillin
  - not FDA approved for plumbism
- succimer (DMSA) (Chemet) PO, for outpatient chelation
  - 3 weeks of therapy
  - 10 ug/kg PO every 8 hours for 1st 5 days
  - 10 ug/kg PO every 12 hours for next 14 days
iron poisoning
- deferoxamine 10-15 mg/kg/hr IM or IV until serum iron < 250 ug/dL

of no benefit for coronary artery disease^[2]
slight benefit for coronary artery disease^[3] (many skeptics of study)
slight benefit for secondary pevention of myocardial infarction^[4] (editor skeptical)

↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1155, 1167-68
↑ ^2.0 ^2.1 Journal Watch 22(4):28, 2002 Knudtson ML et al. for the Program to Assess Alternative Treatment Strategies to Achieve Cardiac Health (PATCH) Investigators. Chelation therapy for ischemic heart disease: A randomized controlled trial. JAMA 2002 Jan 23/30; 287:481-6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/11798370
↑ ^3.0 ^3.1 Pollack A Much-Debated Treatment for Heart Disease Shows Slight Benefit in Clinical Trial New York Times. November 4, 2012 Report from the 2012 American Heart Association Meeting http://www.nytimes.com/2012/11/05/health/chelation-therapy-shows-slight-benefit-in-heart-disease-clinical-trial.html?_r=0
↑ ^4.0 ^4.1 Lamas GA Effect of Disodium EDTA Chelation Regimen on Cardiovascular Events in Patients With Previous Myocardial Infarction. The TACT Randomized Trial. JAMA. 2013;309(12):1241-1250 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23532240 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1672238
Nissen SE Concerns About Reliability in the Trial to Assess Chelation Therapy (TACT). JAMA. 2013;309(12):1293-1294 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23532246 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1672219
↑ Learn More About Chelation Therapy and the Study http://www.nccam.nih.gov/chelation/chelationstudy.htm