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dimercaprol (Rx)Brand and Other Names:BAL

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 100mg dimercaprol-210mg benzyl benzonate-680mg peanut oil/mL
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Arsenic/Gold Poisoning

Day 1-2: 10-12 mg/kg/day divided q6hr deep IM x2 days 

Day 3: 5-6 mg/kg/day divided q12hr deep IM x1 days

Day 4-14: 2.5-3 mg/kg deep IM qDay x11 days

Severe gold dermatitis: 2.5 mg/kg IM q4hr x2 days, then BID x1 week

Gold-induced thrombocytopenia: 100 mg IM BID x15 days

Mercury Poisoning

Day 1: 5 mg/kg deep IM qDay x1 day 

Day 2-11: 2.5 mg/kg deep IM q12-24hr x10 days

Lead Poisoning

Initial 4 mg/kg (75-83 mg/sq. meter) IM 

Repeat dose at least 4 hours later (but not until adequate urine flow established), THEN

4 mg/kg (75-83 mg/sq. meter) + EDTA 250 mg/sq. meter IM q4hr x3-5 days

If blood lead concentration rebounds to >45 mcg/dL [2.174 micromoles/L] within 5-7 days, may repeat course of treatment (usually just EDTA without dimercaprol)

Wilson Disease (Off-label)

Rarely used because of deep IM injection of 2-3 mL that is painful

2.5-3 mg/kg IM BID/TID

Dosing considerations

  • Adjust dose to achieve urinary copper excretion of 0.5-1 mg/day
  • Free copper levels in serum: Maintain at <10 mcg/dL

Other Information

Preadministered antihistamine may decrease side effects

Other Indications & Uses

Do not use in iron, cadmium, or selenium due to formation of toxic complexes

Use with other agents (CaNa-EDTA) in acute lead poisoning

Dosage Forms & Strengths

injectable solution

  • 100mg dimercaprol-210mg benzyl benzonate-680mg peanut oil/mL
more...

Administer same as in adults

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Adverse Effects

Frequency Not Defined

Fever, 30% of children (frequent)

Tightness sensation, Chest, limbs, jaw, abdomen

Hypertension (frequennt, dose related)

Tachycardia (frequent, dose related)

Injection site pain, abscess

Nausea/Vomiting

Headache

Paresthesia (hand)

Tremor

Blepharospasm

Conjunctivitis

Lacrimation

Nasal discharge

Nephrotoxicity

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Warnings

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

Cautions

Do not use in iron, cadmium, or selenium due to formation of toxic complexes

Use with other agents (CaNa-EDTA) in acute lead poisoning

Oliguria, G6PD deficiency

Discontinue if renal failure occurs

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Pregnancy & Lactation

Pregnancy Category: C

Lactation: excretion in milk unknown; use with caution

Pregnancy Categories

A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA:Information not available.

more...
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Pharmacology

Mechanism of Action

Formation of stable, non-toxic excretable ( in bile & urine) cyclic compound

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Images

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Formulary

FormularyPatient Discounts

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The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

Tier Description
1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
NC NOT COVERED – Drugs that are not covered by the plan.
Code Definition
PA Prior Authorization
Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
QL Quantity Limits
Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
ST Step Therapy
Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
OR Other Restrictions
Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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