dimercaprol (BAL, British anti-Lewisite, dithioglycerol, Sulfactin, Dimersol, Antoxol, Panobal)
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Introduction
Tradename: BAL in oil.
Indications
- heavy metal poisonings:
- adjunctive treatment in lead poisoning
- adjunctive treatment in Wilson's disease
Contraindications
Caution:
- give all injections deep IM
- urinary alkalinization recommended to protect kidney
- use with caution in patients with oliguria
Dosage
- lead toxicity
- 4 mg/kg, then 3-4 mg/kg every 4 hours for 5-7 days (4 mg/kg for severe lead toxicity)
- 3 mg/kg every 4 hours for 2 days, then QID on day 3, then BID for 10 days[3]
- alkalinization of the urine is necessary
- mercury poisoning
- arsenic & gold poisoning
Pharmacokinetics
- peak concentrations are obtained within 30 minutes of IM dosing
- distributes mainly ito intracellular space of tissues, including brain, kidney & liver
- inactivated by the liver
- excreted in the urine
Adverse effects
- common (> 10%)
- less common (1-10%)
- uncommon (< 1%)
- nervousness, anxiety, fever, headache, neutropenia (transient), pain at injection site, blepharospasm, nephrotoxicity, salivation, mucosal "burning" (lips, mouth, throat, eyes, penis)
- other
- breath odor
- hemolysis in patients with G6PD deficiency
Mechanism of action
- contains sulfhydryl groups that bind heavy metals
More general terms
Additional terms
References
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1168
- ↑ 3.0 3.1 Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ Department of Veterans Affairs, VA National Formulary