Dosing and uses of Calcium Disodium Versenate (edetate calcium disodium)
Adult dosage forms and strengths
injectable solution
- 200mg/mL
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
Pediatric dosage forms and strengths
injectable solution
- 200mg/mL
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
Calcium Disodium Versenate (edetate calcium disodium) adverse (side) 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
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
Pregnancy and 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.
Pharmacology of Calcium Disodium Versenate (edetate calcium disodium)
Mechanism of action
Chelating agent to enhance elimination of metals, particulary lead
Agent being chelated takes place of Ca++
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
