Which medications in the drug class Chelating Agents are used in the treatment of Mercury Toxicity?

Updated: Nov 05, 2018
  • Author: David A Olson, MD; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS  more...
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Answer

Chelating Agents

These agents are used to help remove a portion of the body's mercury stores. They are administered early in treatment because mercury binds to the body's ubiquitous sulfhydryl groups. Chelating agents are thought to use their thiol groups to compete with sulfhydryl groups in binding methyl mercury. The effectiveness of chelation in preventing or treating neurologic toxicity has not been well evaluated.

Succimer (Chemet)

DMSA is used in inorganic and organic mercurials. It is considered superior to penicillamine because it has fewer adverse effects. Because of this agent's ease of use, good efficacy, and safety, initiate treatment with DMSA if good evidence indicates that significant absorption can occur (mercury levels may not be readily available). DMSA is the chelator of choice in cases of chronic or mild toxicity.

Dimercaprol (BAL)

This is the drug of choice for the treatment of acute inorganic mercury toxicity. It is the preferred chelator for mercury salts. Dimercaprol is administered intramuscularly every 4 hours, mixed in a peanut oil base. It is excreted in urine and bile. Dimercaprol may be given to patients with renal failure. The BAL-mercury complex is dialyzable. Dimercaprol is used only in acute ingestion.

D-penicillamine (Depen, Cuprimine)

D-penicillamine is an oral, thiol-based chelator for acute or chronic toxicity. It is less well tolerated than DMSA (succimer). D-penicillamine forms a complex with mercury and is excreted in urine; therefore, do not use it in renal failure. This agent cannot be considered a first-line drug, because DMSA is safer and more effective.


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