What is the role of medications in the treatment of lead toxicity?

Updated: Jan 16, 2020
  • Author: Pranay Kathuria, MD, FACP, FASN, FNKF; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS  more...
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Answer

The mainstay of treatment is chelation therapy. Chelation agents contain sulfhydryl groups that bind or chelate lead, and the resulting complex is excreted either renally or hepatically. The chelation agents succimer and penicillamine are given orally, whereas dimercaprol and edetate (EDTA) calcium disodium (CaNa2 EDTA) are administered parenterally.

These agents reduce body stores of lead. Reducing blood lead levels also may mobilize skeletal stores of lead. Therefore, caution must be exercised in using chelation agents, both because of their adverse effects and because of their ability to mobilize lead.

Dimercaptopropanesulfonic acid (DPMS) has received much attention worldwide, but it is not yet available in the United States, except under special FDA Investigational New Drug (IND) permits. In Europe and Asia, DPMS has become the drug of choice for most heavy metal intoxications. It is available both in an oral form and in a water-based parenteral form.


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