Succimer

Information about Succimer

Succimer is an oral heavy metal chelating agent used to treat lead and heavy metal poisoning.

Liver safety of Succimer

Succimer has been linked to a low rate of transient serum aminotransferase elevations during therapy, but its use has not been linked to cases of clinically apparent liver injury with jaundice.

Mechanism of action of Succimer

Succimer (sux’ i mer) or dimercaptosuccinic acid (DMSA) is an orally available heavy metal chelating agent that is used to treat lead poisoning in children. Succimer is an organo-sulfur compound with two sulfhydryl groups that bind divalent metal ions such as lead, cadmium, mercury, and arsenic. Succimer does not significantly chelate essential metals such as zinc, copper or iron, and its specificity, safety and oral availability make it preferable to other chelating agents for treating lead poisoning such as Ca-EDTA which must be given intravenously and dimercaprol (British anti-Lewisite [BAL]) which requires intramuscular administration. Succimer has been shown to lower blood lead levels and improve symptoms of chronic lead poisoning.

FDA approval information for Succimer

Succimer was approved for use in the United States in 1991, and current indications are for treatment of lead poisoning in pediatric patients with plasma lead levels above 45 µg/dL. It is used off label to treat adults with lead poisoning and for therapy of arsenic and mercury intoxication. Succimer is also used in naturopathic medicine as a part of chelation therapy for various conditions.

Dosage and administration for Succimer

Succimer is available in capsules of 100 mg generically and under the brand name Chemet. The recommended dose is 10 mg/kg (or 30 mg/m2) every 8 hours for 5 days, with 2 week rest periods between repeated courses if lead levels remain high.

Side effects of Succimer

Side effects are generally mild and may include headache, nausea, anorexia, diarrhea, rash and renal dysfunction. Uncommon, but potentially severe adverse events include hypersensitivity reactions.

Arsenic Chelators

• Dimercaprol

Copper Chelators (for Wilson Disease)

• Dimercaprol
• Penicillamine
• Trientine
• Zinc

Iron Chelators

• Deferasirox
• Deferiprone
• Deferoxamine

Lead Chelators

• Dimercaprol
• EDTA
• Succimer

Mercury Chelators

• Dimercaprol

• Dailymed label info on Succimer
• FDA Succimer

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  Meso-2,3-dimercaptosuccinic acid 2D skeletal A configurations
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  DMSA 3D balls
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  (2R,3R)-2,3-dimercaptosuccinic acid 2D skeletal A configurations
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  (2S,3S)-2,3-dimercaptosuccinic acid 2D skeletal A configurations
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  (2R,3R)-2,3-dimercaptosuccinic acid 2D skeletal B configurations
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  Meso-2,3-dimercaptosuccinic acid 2D skeletal B configurations
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  (2S,3S)-2,3-dimercaptosuccinic acid 2D skeletal B configurations