Dosing and uses of BAL (dimercaprol)
Adult dosage forms and strengths
injectable solution
- 100mg dimercaprol-210mg benzyl benzonate-680mg peanut oil/mL
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
Pediatric dosage forms and strengths
injectable solution
- 100mg dimercaprol-210mg benzyl benzonate-680mg peanut oil/mL
Administer same as in adults
BAL (dimercaprol) adverse (side) 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
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
Pregnancy and 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.
Pharmacology of BAL (dimercaprol)
Mechanism of action
Formation of stable, non-toxic excretable ( in bile & urine) cyclic compound
