![]() ![]() Rare, but potentially severe adverse events include seizures, stupor and coma. Side effects include injection site reactions, local pain and sterile abscesses as well as systemic symptoms such as nausea, vomiting, headache, dizziness, spasms, sweating, excessive lacrimation or salivation, and skin or body tingling, burning and pain. Dimercaprol is not indicated and may be harmful in iron, cadmium and selenium poisoning. The recommended dose and regimen vary by indication, but are in the range of 2.5 to 5 mg/kg two to five times daily, given by deep intramuscular injection for 2 to 10 days. Dimercaprol is available in solution in oil in ampules of 300 mg (100 mg/mL) generically and under the name BAL. Dimercaprol is occasionally used in the initial treatment of severe, symptomatic Wilson disease, but generally for a short time only. In addition, dimercaprol has been used to chelate copper in patients with Wilson disease, but now has been replaced by better tolerated oral chelating agents such as penicillamine and trientine. Dimercaprol binds mercury, lead, copper, gold and arsenic, and its major current indications are for poisoning with arsenic, gold and mercury and, in combination with EDTA-calcium, acute lead poisoning. Dimercaprol is a simple propranol molecule with two sulfhydryl groups that acts by binding heavy metals, and thus competing and blocking the binding of the toxic metals to sulfhydryl containing metabolic enzymes. Dimercaprol was developed at Oxford University during World War II as a means of treating and reversing poisoning from Lewisite, an arsenical gas used in chemical warfare (and thus initially called British anti-Lewisite ). The currently recommended treatment is 2-3-dimercapto-1-propanesulfonate (DMPS) or meso 2, 3-dimer-captosuccinic acid (DMSA). Dimercaprol (dye” mer cap’ rol) is a parenterally administered heavy metal chelating agent which has been used to treat arsenic, copper, gold, lead and mercury poisoning as well as severe cases of Wilson disease. Dimercaprol (2, 3 dimercaptopropanol, also known as British anti Lewisite or BAL), was previously the most frequently recommended chelating agent for arsenic.
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