Succimer (Chemet from Sanofi-Synthelabo) is an oral heavy metal chelating agent that can be used to treat children with heavy metal poisoning. The dose is determined by the patient's body weight and is given in one or more courses of therapy.
Dosing is 10 mg/kg or 350 mg per meter square BSA. Since the drug is available only in 100 mg capsules, the dose may be rounded.
Body Weight in Kilograms
Dose in mg
Number of 100 mg Capsules
8 – 15 kg
100
1
16 – 23
200
2
24 – 34
300
3
35 – 44
400
4
>= 45
500
5
Dosing course – 19 days:
(1) day 1 to 5: number of capsules every 8 hours (tid)
(2) day 6 to 19: number of capsules every 12 hours (bid)
total number of capsules to dispense =
= (3 * 5 * (number capsules per dose)) + (2 * 14 * (number of capsules per dose)) =
= 43 * (number of capsules per dose)
Repeat course may be necessary based on weekly blood lead concentrations. At least 2 weeks should separate courses unless the serum lead level dictates the need for rapid therapy.
If the patient ahs received EDTA with or without BAL, succimer can be used after an interval of 4 weeks. EDTA should not be used simultaneously with succimer.
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