Tags

Type your tag names separated by a space and hit enter

Use of oral dimercaptosuccinic acid (succimer) in adult patients with inorganic lead poisoning.
QJM. 2009 Oct; 102(10):721-32.QJM

Abstract

BACKGROUND

Chelation therapy has been used as a means of reducing the body burden of lead for five decades. Intravenous sodium calcium edetate has been the preferred agent, but there is increasing evidence that dimercaptosuccinic acid (DMSA) is also a potent chelator of lead.

METHODS

Oral DMSA 30 mg/kg/day was administered to adults with blood lead concentrations > or = 50 microg/dl. The impact of DMSA on urine lead excretion, on blood lead concentrations and on symptoms was observed. The incidence and severity of adverse effects was also recorded.

RESULTS

Thirty-five courses were given to 17 patients. DMSA significantly (P < 0.0001) increased urine lead excretion and significantly (P < 0.0001) reduced blood lead concentrations. Mean daily urine lead excretion exceeded the pre-treatment value by a median of 12-fold with wide variation in response (IQR 8.9-14.8, 95% CI 10.1-14.6). Pre-treatment blood lead concentrations correlated well with 5-day urine lead excretion. Headache, lethargy and constipation improved or resolved in over half the patients within the first 2 days of chelation. DMSA was generally well tolerated, but one course was discontinued due to a severe mucocutaneous reaction. There was a transient increase in alanine aminotransferase (ALT) activity during 14% of chelations. DMSA caused a significant increase in urine copper (P < 0.0001) and zinc (P < 0.05) excretion.

CONCLUSION

Oral DMSA 30 mg/kg/day is an effective antidote for lead poisoning, though there is a wide inter- and intra-individual variation in response.

Authors+Show Affiliations

West Midland Portion Unit, City Hospital, University of Birmingham, Birmingham, B18 7QH, UK.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19700440

Citation

Bradberry, S, et al. "Use of Oral Dimercaptosuccinic Acid (succimer) in Adult Patients With Inorganic Lead Poisoning." QJM : Monthly Journal of the Association of Physicians, vol. 102, no. 10, 2009, pp. 721-32.
Bradberry S, Sheehan T, Vale A. Use of oral dimercaptosuccinic acid (succimer) in adult patients with inorganic lead poisoning. QJM. 2009;102(10):721-32.
Bradberry, S., Sheehan, T., & Vale, A. (2009). Use of oral dimercaptosuccinic acid (succimer) in adult patients with inorganic lead poisoning. QJM : Monthly Journal of the Association of Physicians, 102(10), 721-32. https://doi.org/10.1093/qjmed/hcp114
Bradberry S, Sheehan T, Vale A. Use of Oral Dimercaptosuccinic Acid (succimer) in Adult Patients With Inorganic Lead Poisoning. QJM. 2009;102(10):721-32. PubMed PMID: 19700440.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of oral dimercaptosuccinic acid (succimer) in adult patients with inorganic lead poisoning. AU - Bradberry,S, AU - Sheehan,T, AU - Vale,A, Y1 - 2009/08/20/ PY - 2009/8/25/entrez PY - 2009/8/25/pubmed PY - 2012/3/16/medline SP - 721 EP - 32 JF - QJM : monthly journal of the Association of Physicians JO - QJM VL - 102 IS - 10 N2 - BACKGROUND: Chelation therapy has been used as a means of reducing the body burden of lead for five decades. Intravenous sodium calcium edetate has been the preferred agent, but there is increasing evidence that dimercaptosuccinic acid (DMSA) is also a potent chelator of lead. METHODS: Oral DMSA 30 mg/kg/day was administered to adults with blood lead concentrations > or = 50 microg/dl. The impact of DMSA on urine lead excretion, on blood lead concentrations and on symptoms was observed. The incidence and severity of adverse effects was also recorded. RESULTS: Thirty-five courses were given to 17 patients. DMSA significantly (P < 0.0001) increased urine lead excretion and significantly (P < 0.0001) reduced blood lead concentrations. Mean daily urine lead excretion exceeded the pre-treatment value by a median of 12-fold with wide variation in response (IQR 8.9-14.8, 95% CI 10.1-14.6). Pre-treatment blood lead concentrations correlated well with 5-day urine lead excretion. Headache, lethargy and constipation improved or resolved in over half the patients within the first 2 days of chelation. DMSA was generally well tolerated, but one course was discontinued due to a severe mucocutaneous reaction. There was a transient increase in alanine aminotransferase (ALT) activity during 14% of chelations. DMSA caused a significant increase in urine copper (P < 0.0001) and zinc (P < 0.05) excretion. CONCLUSION: Oral DMSA 30 mg/kg/day is an effective antidote for lead poisoning, though there is a wide inter- and intra-individual variation in response. SN - 1460-2393 UR - https://www.unboundmedicine.com/medline/citation/19700440/Use_of_oral_dimercaptosuccinic_acid__succimer__in_adult_patients_with_inorganic_lead_poisoning_ L2 - https://academic.oup.com/qjmed/article-lookup/doi/10.1093/qjmed/hcp114 DB - PRIME DP - Unbound Medicine ER -