Medically reviewed by Drugs.com. Last updated on Aug 20, 2020.
(SUKS si mer)
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Chemet: 100 mg
Brand Names: U.S.
Succimer is an analog of dimercaprol. It forms water soluble chelates with heavy metals which are subsequently excreted renally. Succimer binds heavy metals; however, the chemical form of these chelates is not known.
Rapid but incomplete
Primarily extracellular (Aposhian 1992)
Rapidly and extensively to mixed succimer cysteine disulfides
Urine (~25%) with peak urinary excretion between 2 to 4 hours (90% as mixed succimer-cysteine disulfide conjugates, 10% as unchanged drug); feces (as unabsorbed drug)
Time to Peak
Serum: ~1 to 2 hours
~3 hours (Aposhian 1992)
>95% primarily to albumin (Aposhian 1992)
Use: Labeled Indications
Treatment of lead poisoning in children with serum lead levels >45 mcg/dL
Off Label Uses
Clinical experience suggests the utility of succimer in the treatment of symptomatic lead poisoning in adult patients [Kosnett 2007]. Additional data are necessary to further define the role of succimer in the treatment of this condition.
Clinical experience suggests the utility of succimer in the treatment of organic and inorganic mercury poisoning [Andersen 1999], [ATSDR [Mercury] 2014b], [Drasch 2007], [Kosnett 2013]; succimer is designated an orphan drug by the US Food and Drug Administration (FDA) for this purpose. Additional data are necessary to further define the role of succimer in the treatment of this condition.
Clinical experience suggests the utility of succimer in the treatment of arsenic poisoning [Andersen 1999], [ATSDR [Arsenic and Inorganic Arsenic Compounds] 2014a], [Kosnett 2013]. Additional data are necessary to further define the role of succimer in the treatment of this condition.
Hypersensitivity to succimer or any component of the formulation
Lead poisoning (off-label use) (Kosnett 2007), arsenic poisoning (off-label use) (Kosnett 2013), mercury poisoning (off-label use) (Kosnett 2013): For the treatment of high blood lead levels in adults, chelation therapy is recommended with blood lead levels >50 mcg/dL and significant symptoms; chelation therapy may also be indicated with blood lead levels ≥100 mcg/dL and/or symptoms. Consultation with a clinical or medical toxicologist or poison control center is highly recommended in patients who are being considered for chelation therapy.
Oral: Consider using labeled dose for children: 10 mg/kg/dose (or 350 mg/m2/dose) every 8 hours for 5 days, followed by 10 mg/kg/dose (or 350 mg/m2/dose) every 12 hours for 14 days; Maximum: 500 mg/dose.
Note: Treatment courses may be repeated, but a 2-week interval between courses is generally recommended because lead reequilibrates between the extravascular storage sites (eg, bone) and the vascular compartment.
Refer to adult dosing.
Lead poisoning: Note: For the treatment of high blood lead levels in children, the CDC recommends chelation treatment when blood lead levels are >45 mcg/dL (CDC 2002; ACCLPP 2012). The AAP recommends succimer as the drug used for initial management in asymptomatic children when blood lead levels are >45 mcg/dL and <70 mcg/dL; children with blood lead levels >70 mcg/dL or symptomatic lead poisoning should be treated with parenteral agents (AAP 2005). Treatment courses may be repeated, but 2-week intervals between courses is generally recommended. Patients who have received calcium disodium EDTA with or without BAL may be treated with succimer after at least 4 weeks have passed since treatment.
Children and Adolescents: Oral: 10 mg/kg/dose (or 350 mg/m2/dose) every 8 hours for 5 days followed by 10 mg/kg/dose (or 350 mg/m2/dose) every 12 hours for 14 days; maximum dose: 500 mg/dose. Note: Experts recommend dosing for children <5 years of age should be based on body surface area (AAP 2005; Howland 2015); round doses to the nearest 100 mg
Dosing adjustment for toxicity: Children and Adolescents: ANC <1,200/mm3: The manufacturer recommends withholding treatment; treatment may be cautiously resumed when ANC returns to baseline or >1,500/mm3. Consultation with a medical toxicologist to determine the risk versus benefit of withholding treatment is recommended.
Dosing: Adjustment for Toxicity
ANC <1200 mm3: The manufacturer recommends withholding treatment; treatment may be cautiously resumed when ANC returns to baseline or >1500/mm3. Consultation with a medical toxicologist to determine the risk versus benefit of withholding treatment is recommended.
If unable to swallow whole, capsule may be separated and contents sprinkled on a small amount of soft food, or the contents placed on a spoon and administered followed by fruit drink.
Store between 15°C to 25°C (59°F to 77°F); avoid excessive heat.
There are no known significant interactions.
False-positive ketones (U) using nitroprusside methods, falsely decreased serum CPK; falsely decreased uric acid measurement
1% to 10%:
Cardiovascular: Cardiac arrhythmia (adults: 2%)
Hepatic: Increased serum transaminases (6% to 10%)
Frequency not defined:
Central nervous system: Chills, dizziness, drowsiness, fatigue, flank pain, headache, heavy headedness, metallic taste, paresthesia, sensorimotor neuropathy
Dermatologic: Mucocutaneous eruptions, papular rash, pruritus, skin rash, vesicular eruption (mucocutaneous)
Endocrine & metabolic: Increased serum cholesterol
Gastrointestinal: Abdominal cramps, decreased appetite, diarrhea, hemorrhoids, loose stools, nausea, sore throat, stomach pain, vomiting
Genitourinary: Decreased urine output, difficulty in micturition, proteinuria
Hematologic & oncologic: Eosinophilia, neutropenia, quantitative disorders of platelets (increase)
Hepatic: Increased serum alkaline phosphatase
Infection: Candidiasis, common cold, herpetic lesion
Neuromuscular & skeletal: Back pain, knee pain, lower extremity pain, rib pain
Ophthalmic: Cloudy vision (cloudy film in eye), watery eyes
Otic: Blockage of external ear, otitis media
Respiratory: Cough, flu-like symptoms, nasal congestion, rhinorrhea
<1%, postmarketing, and/or case reports: Angioedema, hypersensitivity reaction (especially with retreatment), urticaria
Concerns related to adverse effects:
• Hematologic effects: Mild-to-moderate neutropenia has been reported; evaluate CBC with differential at baseline, weekly during treatment, and immediately upon the development of any sign of infection. The manufacturer recommends withholding treatment for ANC <1200/mm3; treatment may be cautiously resumed when ANC returns to baseline or >1500/mm3. Consultation with a medical toxicologist to determine the risk versus benefit of withholding treatment is recommended.
• Hepatic effects: Transient elevations in serum transaminases have been reported. Evaluate serum transaminases at baseline and weekly during treatment; more frequent monitoring may be required in patients with a history of liver disease.
• Hypersensitivity reactions: Monitor for the development of allergic or other mucocutaneous reactions. A reversible mucocutaneous vesicular eruption of the oral mucosa, external urethral meatus, or perianal area has been reported (rarely).
• Encephalopathy: Succimer does not cross blood-brain barrier and should not be used to treat encephalopathy associated with lead toxicity.
• Lead poisoning: Investigate, identify, and remove sources of lead exposure prior to treatment; do not permit patients to re-enter the contaminated environment until lead abatement has been completed. Primary care providers should consult experts in chemotherapy of heavy metal toxicity before using chelation drug therapy. Succimer is not used to prevent lead poisoning. A rebound rise in serum lead levels may occur after treatment as lead is released from storage sites into blood. The severity of rebound may guide the frequency of future monitoring and the need for additional chelation therapy.
• Renal impairment: Use with caution in patients with renal impairment. Succimer is dialyzable; however, the lead chelates are not.
• Hydration: Adequate hydration should be maintained during therapy.
Blood lead levels (baseline and 7 to 21 days after completing chelation therapy); serum aminotransferase (baseline and weekly during treatment; may require more frequent monitoring in patients with a history of liver disease), CBC with differential and platelets (baseline, and weekly during treatment); hemoglobin or hematocrit, iron status, free erythrocyte protoporphyrin or zinc protoporphyrin; neurodevelopmental changes
Adverse events were observed in animal reproduction studies.
Lead poisoning: Lead is known to cross the placenta in amounts related to maternal plasma levels. Prenatal lead exposure may be associated with adverse events such as spontaneous abortion, preterm delivery, decreased birth weight, and impaired neurodevelopment. Some adverse outcomes may occur with maternal blood lead levels <10 mcg/dL. In addition, pregnant women exposed to lead may have an increased risk of gestational hypertension. Consider chelation therapy in pregnant women with confirmed blood lead levels ≥45 mcg/dL (pregnant women with blood lead levels ≥70 mcg/dL should be considered for chelation regardless of trimester); consultation with experts in lead poisoning and high-risk pregnancy is recommended. Encephalopathic pregnant women should be chelated regardless of trimester (CDC 2010).
What is this drug used for?
• It is used to treat lead poisoning.
All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:
• Metallic taste
• Lower back pain
• Side pain
• Abdominal cramps
• Abdominal pain
• Flu-like signs
• Loss of strength and energy
• Common cold symptoms
• Lack of appetite
WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:
• Rectal irritation
• Ear pain
• Burning or numbness feeling
• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.
Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a limited summary of general information about the medicine's uses from the patient education leaflet and is not intended to be comprehensive. This limited summary does NOT include all information available about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not intended to provide medical advice, diagnosis or treatment and does not replace information you receive from the healthcare provider. For a more detailed summary of information about the risks and benefits of using this medicine, please speak with your healthcare provider and review the entire patient education leaflet.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.