Dimercaprol

Administration

• Type: Chelator, Antidote
• Dosage Forms:
• Routes of Administration: IM
• Common Trade Names: British antilewisite (BAL)

Adult Dosing

• Arsenic or gold toxicity, mild: 2.5 mg/kg IM 4 times per day x 2 days, BID on day 3, then daily x 10 days
• Arsenic or gold toxicity, severe: 3 mg/kg IM q4 hours x 2 days, 4 times on day 3, then BID x 10 days
• Mercury toxicity: 5mg/kg IM on day 1, then 2.5 mg/kg 1-2 times daily x 10 days
• Lead poisoning, mild: 4 mg/kg IM for initial dose, then 3 mg/kg q4 hourr for 2-7 days in combination with edetate calcium disodium (EDTA)
• Lead poisoning, severe: 4 mg/kg IM every 4 hr for 2-7 days in combination with edetate calcium disodium (EDTA)

Pediatric Dosing

• Same as above

Special Populations

• Pregnancy Rating: C
• Lactation risk: Infant risk cannot be ruled out
• Renal dosing: use at reduced dose and with caution
• Hepatic dosing: contraindicated in hepatic insufficiency

Contraindications

• Allergy to class/drug
• Hepatic insufficiency (unless due to arsenic)

Adverse Reactions

Serious

• Tachycardia, hypertension
• Fever

Common

• Fever
• Bronchospasm, chest tightness
• Headache, paresthesias, tremor
• Blepharospasm, conjunctivitis

Pharmacology

• Half-life:
• Metabolism:
• Excretion:

Mechanism of Action

• Binds thiol group on heavy metals, preventing those groups from binding/inhibiting enzymes and allowing urinary excretion of metals

Indications by Condition

The following table is automatically generated from disease/condition pages across WikEM.

Indication	Dose	Context	Route	Population
Copper sulfate toxicity	3-5mg/kg/dose IM q4hr x 2 days, then taper over 7-11 days	Chelation, first-line for severe	IM	Adult
Lead toxicity	50-75mg/m2 IM q4hr x 3-5 days	First-line if encephalopathy present	IM	Adult
Mercury toxicity	2.5-5mg/kg IM q6-12hr	Chelation, severe or inorganic mercury	IM	Adult

See Also

• Toxicology (main)
• Heavy metals
• Antidotes
• Arsenic
• Lead toxicity
• Mercury toxicity