Succimer

Succimer is a chelating agent used in the treatment of lead poisoning.

• Succimer is available under the following different brand names: Chemet

Common side effects of Succimer include:

• nausea,
• vomiting,
• loss of appetite,
• diarrhea,
• metallic taste in the mouth,
• drowsiness,
• dizziness,
• watering eyes, or
• headache

Serious side effects of Succimer include:

• fever, cold or flu symptoms, cough, trouble breathing;
• skin sores, rash; or
• swollen gums, painful mouth sores, and pain when swallowing.

Rare side effects of Succimer include:

• none

Seek medical care or call 911 at once if you have the following serious side effects:

• Severe headache, confusion, slurred speech, arm or leg weakness, trouble walking, loss of coordination, feeling unsteady, very stiff muscles, high fever, profuse sweating, or tremors;
• Serious eye symptoms such as sudden vision loss, blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;
• Serious heart symptoms include fast, irregular, or pounding heartbeats; fluttering in the chest; shortness of breath; sudden dizziness, lightheadedness, or passing out. 

This is not a complete list of side effects and other serious side effects or health problems that may occur because of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

Adult and pediatric dosage

Capsule

• 100 mg

Lead Poisoning

Pediatric dosage

• Aged below 1 year: Safety and efficacy not established
• 1 year or older: Blood lead levels above 45 mcg/dL, 10 mg/kg, or 350 mg/sq.meter every 8 hours for 5 days, then 10 mg/kg or 350 mg/sq.meter every 12 hours for 14 days 

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

If your medical doctor is using this medicine to treat your pain, 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.

• Succimer has no noted severe interactions with any other drugs.
• Succimer has no noted serious interactions with any other drugs.
• Succimer has no noted moderate interactions with any other drugs.
• Succimer has no noted minor interactions with any other drugs.

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist about all your products. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your healthcare professional or doctor for additional medical advice, or if you have health questions or concerns.

Contraindications

• History of hypersensitivity to drugs or excipients

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Succimer?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Succimer?”

Cautions

• Clinical experience with the product is limited; patients should be carefully observed during treatment
• Keep out of reach of pediatric patients; the product is not a substitute for effective abatement of lead exposure
• Mild to moderate neutropenia was reported; while a causal relationship to the drug is not definitely established, neutropenia has been reported with other drugs in the same chemical class; obtain complete blood count with white blood cell differential and direct platelet counts prior to and weekly during therapy; withhold therapy or discontinue if absolute neutrophil count (ANC) is below 1200/mcL and patient followed closely to document the recovery of ANC to above 1500/mcL or to patient’s baseline neutrophil count; there is limited experience with reexposure in patients who have developed neutropenia; such patients should be rechallenged only if the benefit of therapy clearly outweighs the potential risk of another episode of neutropenia and then only with careful patient monitoring; patients treated with the product should be instructed to promptly report any signs of infection; if infection suspected, the above laboratory tests should be conducted immediately
• Elevated blood lead levels and associated symptoms may return rapidly after discontinuation of therapy because of redistribution of lead from bone stores to soft tissues and blood; after therapy, monitor patients for the rebound of blood lead levels, by measuring blood lead levels at least once weekly until stable; however, the severity of lead intoxication (as measured by initial blood lead level and rate and degree of rebound of blood lead) should be used as a guide for more frequent blood lead monitoring
• All patients undergoing treatment should be adequately hydrated; use caution in patients with compromised renal function; limited data suggest that the product is dialyzable, but that the lead chelates are not
• Transient mild elevations of serum transaminases were observed in 6-10% of patients during the course of therapy; monitor serum transaminases before the start of therapy and at least weekly during therapy; monitor closely patients with a history of liver disease; no data are available regarding the metabolism of drugs in patients with liver disease
• Clinical experience with repeated courses limited; safety of uninterrupted dosing longer than three weeks not established and not recommended
• The possibility of allergic or other mucocutaneous reactions to the drug must be borne in mind on administration (as well as during initial courses); patients requiring repeated courses of therapy should be monitored during each treatment course; one patient experienced recurrent mucocutaneous vesicular eruptions of increasing severity affecting the oral mucosa, external urethral meatus and perianal area on the third, fourth and fifth courses of therapy; the reaction resolved between courses and upon discontinuation of therapy

Pregnancy and Lactation

• Succimer has been shown to be teratogenic and fetotoxic in pregnant mice when given subcutaneously in a dose range of 410 to 1640 mg/kg/day during the period of organogenesis; in a developmental study in rats, succimer produced maternal toxicity and deaths at the dose of 720 mg/kg/day or more during organogenesis
• The dose of 510 mg/kg/day was the highest tolerable dose in pregnant rats; impaired development of reflexes was noted in pups of 720 mg/kg/day group dam; there are no adequate and well-controlled studies in pregnant women; therapy should be administered during pregnancy only if the potential benefit justifies the potential risk to the fetus
• Lactation
  • Not known whether this drug is excreted in human milk; because many drugs and heavy metals are excreted in human milk, nursing mothers requiring therapy should be discouraged from nursing their infants