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Brand Name :
BAL in oil
Synonyms :
Dimercaprol, sulfactin, dimercaprolum, dimercaptopropnol
Class :
Antidote
Brand Name :
BAL in oil
Synonyms :
Dimercaprol, sulfactin, dimercaprolum, dimercaptopropnol
Class :
Antidote
Dosage Forms & Strengths
Injectable solution
100mg dimercaprol,210mg benzyl benzonate,680mg peanut oil/ml
Day 1-2: 10-12mg/kg/day divided every 6 hours intramuscular for two days
Day 3: 5-6mg/kg/day divided every 12 hours intramuscular for one day
Day 4-14: 2.5-3mg/kg/day everyday intramuscular for 11 days
Gold induced thrombocytopenia:100mg intramuscularly twice a day for 15 days
Gold dermatitis:2.5mg/kg intramuscular every 4 hours for two days, then twice a day for one week
Initial dose: 4mg/kg intramuscular. Repeat dose after 4 hours
4mg/kg +EDTA 250mg/sq.mt intramuscular every 4 hours for 3-5 days
Day 1:5mg/kg intramuscular every day for one day
Day 2-11:2.5mg/kg deep intramuscular every 12-24 hours for ten days
Refer adult dosing
Refer adult dosing
may increase the nephrotoxic effect of iron preparations
may increase the nephrotoxic effect of iron preparations
may increase the nephrotoxic effect of iron preparations
may increase the nephrotoxic effect of iron preparations
may enhance the toxic effect of multivitamins/minerals
may increase GI bleeding, ulceration and irritation
may increase GI bleeding, ulceration and irritation
may increase GI bleeding, ulceration and irritation
may increase GI bleeding, ulceration and irritation
may increase GI bleeding, ulceration and irritation
may decrease the absorption of iron preparations
may decrease the absorption of iron preparations
may decrease the absorption of iron preparations
may decrease the absorption of iron preparations
may decrease the absorption of iron preparations
dimercaprol has the potential to reduce the rate of excretion of idebenone, leading to an elevation in levels of serum
dimercaprol: they may enhance the serum concentration of CYP2D6 Inhibitors
dimercaprol: they may enhance the serum concentration of CYP2D6 Inhibitors
dimercaprol: they may enhance the serum concentration of CYP2D6 Inhibitors
dimercaprol: they may enhance the serum concentration of CYP2D6 Inhibitors
dimercaprol: they may enhance the serum concentration of CYP2D6 Inhibitors
dimercaprol: they may diminish the serum concentration of CYP3A4 Inducers
dimercaprol: they may diminish the serum concentration of CYP3A4 Inducers
dimercaprol: they may diminish the serum concentration of CYP3A4 Inducers
dimercaprol: they may diminish the serum concentration of CYP3A4 Inducers
dimercaprol: they may diminish the serum concentration of CYP3A4 Inducers
sodium ferric gluconate complexÂ
Certain metals, such iron and selenium, can combine with dimercaprol to generate toxic complexes that damage the kidneys. During dimercaprol therapy, products containing iron or selenium should not be utilized.
Mechanism of action
It binds to heavy metal ions such as lead, arsenic, and mercury, creating a more water-soluble complex that can be excreted from the body. This binding effectively “detoxifies” the heavy metals and reduces their toxic effects
Spectrum
It is primarily used to treat heavy metal poisoning, specifically from lead, arsenic, and mercury. It can also poison other metals such as gold, bismuth, and antimony. Dimercaprol is also used to treat Wilson disease, a genetic disorder that causes excessive accumulation of copper in the liver, brain, and other vital organs
Frequency undefined:
Chest tightness
Tachycardia
Nausea/vomiting
Paresthesia
Blepharospasm
Lacrimation
Nephrotoxicity
Fever
Pain at the injection site
Headache
Tremor
Conjunctivitis
Nasal discharge
Contraindications
Hypersensitivity: It should not be used in patients with known hypersensitivity to the drug or its components
High blood pressure: It should not be used in patients with high blood pressure, as it may cause hypertension
Peptic ulcer disease: It should not be used in patients with peptic ulcer disease, as it may cause gastrointestinal bleeding
Severe anemia: It should not be used in patients with severe anemia, as it may cause further deterioration of the condition
Pregnancy and lactation: It should be used with caution in pregnancy and lactation, as it may cause harm to the fetus or nursing infant.
Renal impairment: It should be used with caution in patients with renal impairment, as it may accumulate in the body and cause toxicity.
Concurrent use with other chelating agents: It should not be used concomitantly with other chelating agents, as it may cause toxicity or anaphylaxis
Caution
Side effects: It can cause significant side effects, such as hypertension, gastrointestinal bleeding, anemia, and allergic reactions.
Interactions: It may interact with other medications, including antacids, anti-inflammatory drugs, and sulfonamides.
Renal and liver function: It should be used with caution in patients with renal or liver impairment, as it may accumulate in the body and cause toxicity in these patients.
Anaphylaxis: It may cause anaphylaxis, a severe allergic reaction, in some individuals, particularly those with allergies.
Pregnancy and lactation: It should be used with caution in pregnant and lactating women, as it may cause harm to the fetus or nursing infant.
Monitoring: Close monitoring of vital signs, laboratory values, and clinical response is necessary when administering dimercaprol.
dimercaprol has a pungent odor and may cause local irritation or chemical burns if it comes in contact with the skin or eyes
Pregnancy consideration: C
Lactation: Excretion of the drug in human breast milk is unknown
Pregnancy category:
Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester.
Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women.
Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.
Category D: adequate data available with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.
Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.
Category N: There is no data available for the drug under this category
Pharmacology
It is an oily substance that is not absorbed when taken orally and must be administered via deep intramuscular injection, which is painful and can cause allergic reactions.
Pharmacodynamics
It has been found to increase lead’s neurotoxic effects by moving it to the brain. Additionally, while dimercaprol can increase the excretion of cadmium, it also increases the concentration of cadmium in the kidneys, making it contraindicated in patients with cadmium toxicity
Pharmacokinetics
Absorption:
It is not absorbed orally, as it is an oily substance that does not dissolve in water. It must be administered via deep intramuscular injection
Distribution:
After injection, dimercaprol quickly distributes throughout the body. It has a high affinity for specific tissues, including the liver, kidneys, and brain, and it can also cross the blood-brain barrier
Metabolism:
It is metabolized primarily in the liver by conjugation with glutathione, which makes it water-soluble and increases its excretion
Excretion:
It is excreted primarily in the urine as the conjugated form or as the unchanged compound. The half-life of dimercaprol is about 2-3 hours
Administration
It is administered via deep intramuscular injection. Because of its oily nature, it is not absorbed when taken orally. The usual adult dose of dimercaprol is 3-5 mg/kg of body weight, given every 4 hours for up to 72 hours. Doses can be adjusted based on the toxicity severity and the patient’s response.
It’s important to note that the administration of dimercaprol is painful and can cause allergic reactions. The injection site should be rotated to prevent tissue damage, and the patient should be monitored for signs of an allergic reaction, such as hives, difficulty breathing, or swelling of the face, lips, tongue, or throat. It should also be used with caution in patients with kidney or liver disease, as it may harm these organs.
Patient information leaflet
Generic Name: dimercaprol
Pronounced: [ DYE-mer-KAP-rol ]
Why do we use dimercaprol?
dimercaprol, also known as British Anti-Lewisite (BAL), is a medication primarily used to treat acute heavy metal poisoning, notably lead, arsenic, and mercury
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