Class: Chelating agent
- Capsules 100 mg
Forms water soluble chelate with lead, increasing the urinary excretion.
Rapid but variable absorption with peak levels in 1 to 2 h.
Approximately 49% of the dose excreted (39% feces, 9% urine, 1% as carbon dioxide via the lungs). Elimination t ½ about 2 days.
Indications and Usage
Treatment of lead poisoning in children with blood levels above 45 mcg/dL.
Treatment of heavy metal poisonings (mercury, arsenic); however, further study is needed.
Dosage and AdministrationChildren 12 mo and older
PO Start with 10 mg/kg or 350 mg/m 2 every 8 h for 5 days. Reduce frequency of administration to 10 mg/kg or 350 mg/m 2 every 12 h for an additional 14 days. A course of treatment lasts 19 days. Repeated courses may be necessary if indicated by weekly monitoring of lead blood concentration. A minimum of 14 days between courses is recommended unless lead blood levels indicate the need for more prompt treatment. In young children unable to swallow capsules, the contents of the capsule can be sprinkled on a small amount of soft food or placed on a spoon and followed with fruit drink.
Store at controlled room temperature (59° to 77°F).
Drug InteractionsChelating therapy
Coadministration with other chelation therapy is not recommended.
Laboratory Test Interactions
May interfere with serum and urinary laboratory tests (in vitro, succimer caused false-positive results with ketones in urine using nitroprusside reagents [eg, Ketostix ] and falsely decreased serum uric acid and CPK measurements).
Incidence of adverse reactions stated for children (unless adult is stated), most reactions occur more frequently in adults.
Arrhythmia (1.8% adults).
Head pain, heavy head/tired, head cold, headache (5.2% children, 15.7% adults); drowsiness, dizziness, sensorimotor neuropathy, sleepiness, paresthesia (1% children, 12.7% adults).
Papular rash, herpetic rash, rash, mucocutaneous eruptions, pruritus (2.6% children, 11.2% adults).
Nausea, vomiting, diarrhea, appetite loss, hemorrhoidal symptoms, loose stools, metallic taste in mouth (12% children, 20.9% adults); abdominal cramps, stomach pains (5.2% children, 15.7% adults).
Moniliasis (5.2% children, 15.7% adults); decreased urination, voiding difficulty, proteinuria increased (3.7% adults).
Mild to moderate neutropenia, increased platelet count, intermittent eosinophilia (0.5% children, 1.5% adults).
Elevated AST, ALT, alkaline phosphatase, elevated serum cholesterol (4.2% children, 10.4% adults).
Back pain, rib pain (5.2% children, 15.7% adults); kneecap pain, leg pains (3% adults).
Throat sore, rhinorrhea, nasal congestion, cough (3.7% children, 0.7% adults).
Cloudy film in eye, ears plugged, otitis media, eyes watery (1% children, 12.7% adults).
Chills, flank pain, fever, flu-like symptoms (5.2% children, 15.7% adults).
Category C .
Safety and efficacy not established in children younger than 12 mo.
Consider the possibility upon readministration and during the initial courses.
Adequately hydrate patients undergoing treatment. Use with caution in patients with compromised renal function. While succimer appears to be dialyzable, lead chelates are not.
Transient mild elevations of serum transaminases have been reported. Monitor serum transaminases before the start of therapy and at least weekly during therapy. Closely monitor patients with a history of liver disease.
If an infection is suspected, a CBC with WBC differential and direct platelet count should be obtained.
Not a substitute for effective abatement of lead exposure.
Mild to moderate neutropenia has been reported; however, a causal relationship has not been established.
Rebound lead blood levels
Due to redistribution of lead from bone stores to soft tissue and blood, elevated lead blood levels and associated symptoms may return rapidly after discontinuation of succimer. Therefore, monitor for rebound lead blood levels at least weekly.
- Advise patient or caregiver that prescribed dose is to be taken every 8 h for 5 days and then every 12 h for 2 wk. Advise patient or caregiver that regimen may need to be repeated if blood lead levels are still elevated.
- Advise patient or caregiver that good hydration will be important during therapy.
- Instruct patient or caregiver to immediately report rash or any signs of infection to health care provider.
- Advise patient or caregiver that the source of lead exposure must be identified and removed to prevent further exposure to lead.
Copyright © 2009 Wolters Kluwer Health.