Dimercaprol

Dimercaprol is used to treat arsenic/gold poisoning, mercury poisoning, and lead poisoning. Dimercaprol is used off-label in rare cases to treat Wilson disease.

Dimercaprol is available under the following different brand names: BAL.

Adult and Pediatric Dosage Forms and Strengths

Injectable Solution

• 100mg dimercaprol-210mg benzyl benzonate-680mg peanut oil/mL

Dosage Considerations – Should be Given as Follows:

Arsenic/Gold Poisoning

• Day 1-2: 10-12 mg/kg/day divided every 6 hours deep intramuscularly (IM) for 2 days
• Day 3: 5-6 mg/kg/day divided every 12 hours deep IM for 1 day
• Day 4-14: 2.5-3 mg/kg deep IM once daily for 11 days
• Severe gold dermatitis: 2.5 mg/kg IM every 4 hours for 2 days, then twice daily for 1 week
• Gold-induced thrombocytopenia: 100 mg IM twice daily for 15 days

Mercury Poisoning

• Day 1: 5 mg/kg deep IM once daily for 1 day
• Day 2-11: 2.5 mg/kg deep IM every 12-24 hours for 10 days

Lead Poisoning

• Initial 4 mg/kg (75-83 mg/sq. meter) IM
• Repeat dose at least 4 hours later (but not until adequate urine flow established), THEN
• 4 mg/kg (75-83 mg/sq. meter) + EDTA 250 mg/sq. meter IM every 4 hours for 3-5 days
• If blood lead concentration rebounds to greater than 45 mcg/dL [2.174 micromoles/L] within 5-7 days, may repeat course of treatment (usually just EDTA without dimercaprol)

Wilson Disease (Off-label)

• Rarely used because of deep IM injection of 2-3 mL that is painful
• 2.5-3 mg/kg IM twice daily/three times daily

Dosing considerations

• Adjust dose to achieve urinary copper excretion of 0.5-1 mg/day
• Free copper levels in serum: Maintain at less than10 mcg/dL
• Pediatric: Administer same as in adults

Other Information

• Pre-administered antihistamine may decrease side effects

Other Indications and Uses

• Do not use in iron, cadmium, or selenium due to formation of toxic complexes
• Use with other agents (CaNa-EDTA) in acute lead poisoning

Common side effects of Dimercaprol include:

• Fever, 30% of children
• Tightness sensation, chest, limbs, jaw, abdomen
• High blood pressure (hypertension) (dose related)
• Fast heart rate (dose related)

Other side effects of dimercaprol include:

• Injection site pain, abscess
• Nausea
• Vomiting
• Headache
• Numbness and tingling (hand)
• Tremor
• Eyelid twitching
• Conjunctivitis
• Tearing
• Nasal discharge
• Kidney toxicity

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

• Dimercaprol has no listed severe interactions with other drugs.
• Dimercaprol has no listed serious interactions with other drugs.
• Dimercaprol has no listed moderate interactions with other drugs.
• Dimercaprol has no listed mild interactions with other drugs.

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

Warnings

This medication contains dimercaprol. Do not take BAL if you are allergic to dimercaprol or any ingredients contained in this drug.

Contraindications

• Hypersensitivity/allergy to peanuts or any other component (each mL contains 700 mg peanut oil)
• Hepatic insufficiency (except post-arsenical jaundice)
• Not to be administered intravenously (IV)

Effects of Drug Abuse

• No information available

Short-Term Effects

• See "What Are Side Effects Associated with Using Dimercaprol?"

Long-Term Effects

• See "What Are Side Effects Associated with Using Dimercaprol?"

Cautions

• Do not use in iron, cadmium, or selenium due to formation of toxic complexes
• Use with other agents (CaNa-EDTA) in acute lead poisoning
• Oliguria, G6PD deficiency
• Discontinue if renal failure occurs

Pregnancy and Lactation

Use dimercaprol with caution during pregnancy if benefits outweigh risks. Animal studies show risk and human studies are not available or neither animal nor human studies were done.

It is unknown if dimercaprol is excreted in breast milk. Use dimercaprol with caution while breastfeeding.