succimer; 2,3-dimercaptosuccinic acid (DMSA, Chemet)

Introduction

Tradename: Chemet. (also 99Tc succimer)

Indications

• lead poisoning in children with blood levels > 45 ug//dL
• treatment of arsenic poisoning
• treatment of mercury poisoning

Contraindications

• treatment of iron overload

Caution:

• renal insufficiency or hepatic insufficiency
• maintain adequate hydration

Dosage

• 10 ug/kg PO every 8 hours for 1st 5 days, then
• 10 ug/kg PO every 12 for next 14 days

Capsule: 100 mg.

Adverse effects

• common (> 10%)
  • nausea/vomiting, diarrhea, appetite loss, hemorrhoidal symptoms, metallic taste, back pain, fever
• less common (1-10%)
  • elevated liver function tests (AST, ALT, ALP)*, elevated serum cholesterol, influenza-like symptoms, drowsiness, dizziness, rash, sore throat, nasal congestion, cough
• uncommon (< 1%)
  • cardiac arrhythmias

* serum ALT, serum AST, serum alkaline phosphatase

Drug interactions

• not recommended for concurrent use with:
  • edetate calcium disodium
  • penicillamine

More general terms

• chelating agent

Database

• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=9354
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=68726