Dimercaprol
Not yet clinically reviewed
This protocol was migrated from the earlier Pharmapedia and Ward Guide apps for educational use. Follow your hospital's own policies and consult seniors when in doubt.
Introduction
- Was developed by British biochemists at Oxford university during world war II. It was developed secretly as antidote for Lewisite. Lewisite is an organoarsenic compound. It was once manufactured in the U.S., Japan, and Germany for use as a chemical weapon, acting as a vesicant (blister agent) and lung irritant.
- Today it is used medicinally in the treatment of arsenic, mercury and lead and other toxic metal poisoning.
- It has also been used in wilson disease, a genetic disorder in which the body tends to retain copper.
Mechanism of action
- Dimercaprol competes with the sulfahydral groups for binding the metal ion which is then excreted in urine.
Arsenic/Gold Poisoning
- Day 1-2: 10-12 mg/kg/day divided q6hr deep IM x2 days
- Day 3: 5-6 mg/kg/day divided q12hr deep IM x1 days
- Day 4-14: 2.5-3 mg/kg deep IM qDay x11 days
- Gold-induced thrombocytopenia: 100 mg IM BID x15 days
Mercury Poisoning
- Day 1: 5 mg/kg deep IM qDay x1 day
- Day 2-11: 2.5 mg/kg deep IM q12-24hr x10 days
Lead Poisoning
- Initial 4 mg/kg IM
- Repeat dose at least 4 hours later
- THEN
- 4 mg/kg + EDTA 250 mg/sq. meter IM q4hr x3-5 days
- If blood lead concentration rebounds to >45 mcg/dL within 5-7 days, may repeat course of treatment (usually just EDTA without dimercaprol)
Wilson Disease (Off-label)
- 2.5-3 mg/kg IM BID/TID