BAL
Synonym :
Dimercaprol
Mechanism :
It leads to the formation of stable, non-toxic excretable (in bile & urine) cyclic compound. In animal models, dimercaprol prevents and reverses arsenic induced inhibition of sulfhydryl-containing enzymes and if given soon after exposure, may protect against the lethal effects of inorganic and organic arsenicals. Human data suggests that it increases the rate of excretion of excretion of arsenic and lead and may offer therapeutic benefit in the treatment of acute intoxication by arsenic, lead and mercury.
Indication :
- Acute poisoning by arsenic, gold and inorganic mercury.
- Treatment of severe lead poisoning along with EDTA.
Contraindications :
Hypersensitivity/allergy to peanuts or any other component (each mL contains 700 mg peanut oil).
Hepatic insufficiency (except postarsenical jaundice).
Not to be administered IV.
Dosing :
Dosing for children is the same as that in adults.
Arsenic/Gold poisoning:
Day 1-2: 10-12 mg/kg/day divided into 6 hourly doses deep IM for 2 days.
Day 3: 5-6 mg/kg/day divided into 12 hourly doses deep IM for 1 day.
Day 4-14: 2.5-3 mg/kg deep IM daily doses for 11 days.
Severe gold dermatitis:
2.5 mg/kg IM every 4 hourly doses for 2 days, then twice a day for 1 week.
Gold-induced thrombocytopenia:
100 mg IM twice a day for15 days.
Mercury poisoning:
Day 1: 5 mg/kg deep IM single dose.
Day 2-11: 2.5 mg/kg deep IM every 12-24 hours for 10 days.
Lead poisoning:
Initial 4 mg/kg (75-83 mg/m²) IM.
Repeat the dose at least 4 hours later (but not until adequate urine flow is established), followed by 4 mg/kg (75-83 mg/m²) + EDTA 250 mg/m² IM every 4 hours for 3-5 days.
Adverse Effect :
Hypertension, tachycardia nausea, vomiting, tremors, paraesthesia (hand), lacrimation, fever, salivation, pain at injection site, tightness sensation, thrombocytopenia, increased prothrombin time.
Interaction :
It should not be used in iron, cadmium, or selenium poisoning due to formation of toxic complexes.
Hepatic Dose :
Use is contraindicated in hepatic insufficiency except in cases of post-arsenical jaundice.