Succimer
CHEMET
What it isOral dithiol chelator for lead poisoning in children with blood lead levels above 45 mcg/dL.
Why this oneAllows outpatient oral chelation for moderate lead poisoning and causes less essential-metal loss than calcium disodium EDTA.
What limits itIt does not cross the blood-brain barrier or treat lead encephalopathy; remove the exposure source and monitor for rebound lead levels, neutropenia, and transaminitis.
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Lead poisoning | Pediatric | 10 mg/kg or 350 mg/m² q8h (TID) ×5 days | then 10 mg/kg or 350 mg/m² q12h (BID) ×14 days |
Renal Assess renal function (BUN/creatinine/urinary protein) before treatment; succimer and lead are renally excreted.
Hepatic Monitor AST/ALT at baseline and weekly; reduce/interrupt if elevations >5× ULN.
Total 19-day course; minimum 2 weeks between repeat courses; dosing >3 weeks not established.
Instructions
- Ensure adequate hydration.
- Swallow capsules whole when possible; for patients who cannot, sprinkle contents on food or a spoon followed by a drink.
- Interrupt for neutropenia (ANC <1200/mcL); resume when ANC >1500/mcL.
Cautions
- Hypersensitivity and dermatologic reactions (rash, mucocutaneous vesicular eruptions) — interrupt treatment
- Neutropenia — monitor CBC weekly
- Hepatic toxicity — monitor transaminases
- Embryo-fetal toxicity — use effective contraception
- Interference with serum/urinary laboratory tests
Adverse reactions
- GI: nausea, vomiting, diarrhea, appetite loss, hemorrhoidal symptoms, metallic taste
- Elevated ALT/AST
- Rash / mucocutaneous eruptions
- Drowsiness, dizziness
- Neutropenia
Pregnancy May cause fetal harm (animal data); use only if benefit justifies risk; use contraception during and 14 days after.
Lactation No data on presence in milk; women with blood lead ≥40 mcg/dL should not breastfeed.
NO BOXED WARNINGS
Principal riskneutropenia; monitor CBC and interrupt if ANC falls below 1,200/mcL
Cost, est. cash$50–$3,000/use
Generic entryNo US generic
Classes and tags
Clinical profile
Legacy pregnancy categoryUnknown / historical label unavailable
Defining liabilityAllergic, renal or procedure-related complications vary by diagnostic agent and route.
Mechanism of action: Succimer ballicule
