(Redirected from British anti-lewisite)


  • 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


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

Adverse Reactions


  • Tachycardia, hypertension
  • Fever


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


  • 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


See Also