edetate calcium disodium (Rx)

Brand and Other Names:Calcium Disodium Versenate
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 200mg/mL
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Lead Chelation

Asymptomatic, blood lead 20-70 mcg/dL

  • 1 g/sq.meter IV/IM

Symptoms of lead encephalopathy and/or blood lead level >70 mcg/dL

  • Use with dimercaprol (BAL) x5 days
  • IV: 50 mg/kg/day infused over 24 hours, OR 1 g/sq.meter infused over 8-24 hours
  • IM: 250 mg/sq.meter/dose q4hr
  • After 5-day therapy completed, wait at least 2 days before deciding to repeat regimen

Lead nephropathy

  • 500 mg/sq.meter IV/IM q24hr x5 days
  • Serum Cr 3-4 mg/dL: 500 mg/sq.meter IV/IM q48hr x3 doses
  • Serum Cr >4 mg/dL: 500 mg/sq.meter IV/IM qWeek
  • May repeat above regimens at 1 month intervals

Other Indications & Uses

Lead poisoning

Lead encephalopathy must be treated with combination BAL preceeding CaNa2EDTA

May be useful for zinc and manganese poisoning & certain heavy radioisotopes

Dosage Forms & Strengths

injectable solution

  • 200mg/mL
more...

Lead Chelation

Asymptomatic, blood lead 20-70 mcg/dL

  • 1 g/sq.meter IV/IM

Symptoms of lead encephalopathy and/or blood lead level >70 mcg/dL

  • Use with dimercaprol (BAL) x5 days
  • IV: 50 mg/kg/day infused over 24 hours, OR 1 g/sq.meter infused over 8-24 hours
  • IM: 250 mg/sq.meter/dose q4hr
  • After 5-day therapy completed, wait at least 2 days before deciding to repeat regimen
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Adverse Effects

Frequency Not Defined

Renal tubular necrosis

Pain at site

Anorexia

Nausea/vomiting

Cheilosis

Hypercalcemia

Zinc depletion

Dysrhythmias

Inverted T-waves

Bone marrow depression

Anemia

Incr prothrombin times

Malaise

Fatigue

Fever

Chills

Histamine response

Excessive thirst

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Warnings

Black Box Warnings

Edetate calcium disodium is capable of producing toxic effects, which can be fatal. Lead encephalopathy is relatively rare in adults but occurs more often in children in whom it may be incipient and thus overlooked. The mortality rate in children has been high. Patients with lead encephalopathy and cerebral edema may experience a lethal increase in intracranial pressure following intravenous infusion. The intramuscular route is preferred for these patients. In cases where the intravenous route is necessary, avoid rapid infusion. The dosage schedule should be followed, and at no time should the recommended daily dose be exceeded.

Cautions

Oliguria: discontinue if renal failure occurs (dosage adjustment if reduced creatinine clearance)

Pain occurs at inj site

Do NOT use disodium edetate (Na2H2EDTA) for heavy metal toxicity

  • may cause hypocalcemia-related tetany & even death
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Pregnancy & Lactation

Pregnancy Category: B

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.

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Pharmacology

Mechanism of Action

Chelating agent to enhance elimination of metals, particulary lead

Agent being chelated takes place of Ca++

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Administration

Use IM in children and pts at risk for lead encephalopathy (may be lethal IV)

Use 1 mL 1% procaine soln, for each mL chelator to minimize pain at injection site

IV: dilute in 250-500 mL NS or D5W with infusion over 1 hr, if asymptomatic

Symptomatic adults require intermittent IV infusion preferably over 12-24 hr, 4 hr after BAL

Monitor renal function closely

Keep pt well hydrated, adequate urine output

Dialysis will remove chelate if pt has renal failure

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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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