Potent oral chelating agent for a broad range of heavy metals. Agent of choice in very few scenarios due to poor side-effect profile and the existence of better tolerated and more efficacious agents. If possible EDTA or Succimer should be used instead.
- Administer 4-7 mg/kg orally four times a day.
- Maximum dose 2 g/day.
- Months of therapy maybe required.
- Weekly monitoring or urine, full blood count and target heavy metal is recommended.
Adverse Drug reactions/Contraindications:
- As a penicillin derivative it should not be given to those allergic to penicillin.
- Unsuitable for those patients in renal failure as the chelate is excreted via the renal tract.
- The drug is also teratogenic and is to be avoided in pregnancy.
- Erythematous skin reactions and erythema multiforme.
- Bone marrow hypoplasia resulting in thrombocytopenia, leucopenia and fatal agranulocytosis.
- Nephrotic syndrome and glomerulonephritis.
- Good pasture’s syndrome.
- Liebelt EL, Shannon MW. Oral chelators for childhood lead poisoning. Pediatr Ann. 1994 Nov;23(11):616-9, 623-6.
- Shannon MW, Townsend MK. Adverse effects of reduced-dose d-penicillamine in children with mild-to-moderate lead poisoning. Ann Pharmacother. 2000 Jan;34(1):15-8.