Dimercaprol

Indications
 Intramuscular
Heavy metal poisoning
Adult: Initially 400-800 mg on the 1st day of treatment followed by 200-400 mg on the 2nd and 3rd days. Reduce to 100-200 mg on the 4th and subsequent days, all in divided doses. Advisable to give doses at 4 hrly intervals to minimise risk of adverse effects.
Child: 1 mth-18 yr: 2.5-3 mg/kg every 4 hr for 2 days, 2-4 times on the 3rd day, then 1-2 times daily for 10 days or until recovery.
Renal impairment: Use with caution, dosage adjustments may be needed.
Intramuscular
Adjunct in lead poisoning
Adult: Initially 4 mg/kg followed by 3-4 mg/kg of dimercaprol concomitantly with sodium calcium edetate at 4 hrly intervals. Maintenance: 2-7 days.
Renal impairment: Use with caution, dosage adjustments may be needed.
Contraindications
 Iron, selenium, cadmium and organic mercury poisoning, hypersensitivity. Extensive hepatic failure; lactation.
Warnings / Precautions
 Renal damage, hypertension. G6PD deficiency. Elderly. Pregnancy and lactation.
Adverse Reactions
 Hypertension, tachycardia, malaise, salivation, lacrimation, sweating, tingling of extremities, local pain and abscess at inj site, CNS stimulation, nausea, vomiting, burning sensation of lips, mouth, throat and eyes, muscle and abdominal pain, headache, paraesthesia, fever.
Potentially Fatal: Potentiation of toxicity of iron, selenium, tellurium, cadmium, exacerbation of hypertension, haemolytic crisis in patients with G6PD deficiency.
Overdose Reactions
 Symptoms: vomiting, convulsions and stupor within 30 minutes and subsiding within 6 hr following inj.
Drug Interactions
 Drugs which acidify urine may impair the estimation of chelated dimercaprol.
Potentially Fatal: Forms toxic complexes with iron, cadmium, selenium or uranium.
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Lab Interactions
 Interferes with normal accumulation of iodine by the thyroid. Decreased I 131 thyroidal uptake values.
Mechanism of Actions
 Dimercaprol chelates heavy metals e.g. arsenic, gold, mercury, lead as well as antimony, bismuth, nickel and thallium by competing with endogenous sulfhydryl groups on enzymes. This chelation prevents or reverses any inhibition of sulfhydryl enzymes by the metallic poison and forms a complex readily secreted in the kidneys.
Absorption: Peak plasma concentrations after 30-60 min (IM).
Distribution: To all tissues including the brain.
Metabolism: Rapidly hepatic; converted to inactive metabolites.
Excretion: Urine and bile (as metabolites and dimercaprol-metal chelates); 4 hr (elimination half-life).
ATC Classification
 V03AB09 - dimercaprol ; Belongs to the class of antidotes. Used in the management of heavy metals poisoning.
Available As
  • Dimercaprol 50 mg

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