Guidelines for Chelation Therapy
Chelating Drug* | Metal | Dosage† |
|---|---|---|
Deferasirox/deferiprone/deferoxamine | Iron | |
Dimercaprol, 10% in oil | Antimony Arsenic Bismuth Copper salts Gold Lead Mercury Thallium* | 3–4 mg/kg via deep IM injection every 4 hours on day 1; 2 mg/kg IM every 4 hours on day 2; 3 mg/kg IM every 6 hours on day 3; then 3 mg/kg IM every 12 hours for 7–10 days until recovery |
Edetate calcium disodium (calcium disodium edathamil) diluted to≤ 3% | Cobalt Lead Zinc Zinc salts | 25–35 mg/kg via deep IM injection or IV slowly (over 1 hour) every 12 hours for 5–7 days, followed by 7 days without the drug; then repeated |
Penicillamine | Arsenic Copper salts Gold Lead | 5–7.5 mg/kg orally 4 times a day (usual starting dose is 250 mg 4 times a day) to a maximum adult dose of 2 g/day |
Succimer | Arsenic (occupational exposure in adults) Cadmium salts Lead if children have blood lead levels > 45 mcg/dL (> 2.15 micromol/L) Lead (occupational exposure in adults) Mercury (occupational exposure in adults) | 10 mg/kg orally every 8 hours for 5 days, then 10 mg/kg orally every 12 hours for 14 days |
Triethylenetetramine | Copper | Dosing for Wilson disease only‡ 13 years and older: 750 –1250 mg, orally, in divided doses given 2, 3, or 4 times daily; maximum dose: 2000 mg daily 12 and under: 500–750 mg, orally, in divided doses given 2, 3, or 4 times daily; maximum dose: 1500 mg daily |
* Thallium salts are chelated with varying success by this drug (see thallium salts in table Symptoms and Treatment of Specific Poisons). | ||
† Dosages depend on type and severity of poisoning. | ||
‡ This chelating agent was approved in 2018 for treatment of Wilson disease; it was not approved for use in the treatment of exogenous copper intoxication. | ||