Dosing and uses of Chemet (succimer)
Adult dosage forms and strengths
capsule
- 100mg
Lead Poisoning (Off-label)
10 mg/kg PO q8hr for 5 days; follow by 10 mg/kg/dose q12hr for 14 days; not to exceed 500 mg/dose
Chemical name: meso 2,3-dimercaptosuccinic acid (DMSA)
Arsenic Poisoning (Off-label)
300 mg PO q6hr for 3 days
End point: urinary arsenic <50 mcg/L
Cystine Kidney Stone (Orphan)
Prevention of cystine kidney stone formation in patients with homozygous cystinuria prone to stone development
Orphan indication sponsor
- Sanofi Winthrop, Inc; 90 Park Ave; New York, NY 10016-1389
Mercury Intoxication (Orphan)
Treatment of mercury intoxication
Orphan indication sponsor
- Sanofi Winthrop, Inc; 90 Park Ave; New York, NY 10016-1389
Other Information
Key point: Patient should maintain PO fluids
Forms water-soluble chelate with heavy metal (lead, also mercury and arsenic)
Recheck blood lead levels q14Days
Other Indications & Uses
Lead poisoning (child: >45-69 mcg/dL [2.17-3.33 micromoles/L])
Off-label: arsenic poisoning (in combination with BAL)
Pediatric dosage forms and strengths
capsule
- 100mg
Lead Poisoning
<1 year: Safety and efficacy not established
1 year or older: Blood lead levels above 45 mcg/dL, 10 mg/kg or 350 mg/sq.meter q8hr for 5 days, then 10 mg/kg or 350 mg/sq.meter q12hr for 14 days
Other Information
Key point: patient should maintain PO fluids
Recheck blood lead levels q14Days
Chemet: no data for combination with Na2CaEDTA
Geriatric dosage forms and strengths
Lead Poisoning (Off-label)
10 mg/kg PO q8hr for 5 days; follow by 10 mg/kg/dose q12hr for 14 days; not to exceed 500 mg/dose
Arsenic Poisoning (Off-label)
300 mg PO q6hr for 3 days
End point: urinary arsenic <50 mcg/L
Chemet (succimer) adverse (side) effects
Frequency not defined
Nausea/vomiting
Diarrhea
Abd gas/pain
Transient LFTs incr (AST, AP)
Rash
Pruritus
Sore throat
Rhinorrhea
Drowsiness
Paresthesia
Thrombocytosis
Eosinophilia
Possible decr renal function
Fever
Pregnancy and lactation
Pregnancy category: C
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 Chemet (succimer)
Mechanism of action
2 sulfhydryl groups capable of complexing to lead making it water soluble
Pharmacokinetics
Rapid but incomplete
Protein binding: Highly bound to albumin
Excretion: Feces (39%), urine (9%)
Time to peak: 1-2 hr (serum)
Half-life elimination: 2 days
Metabolism: Metabolized extensively to succimer cysteine sulfides
