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succimer

(sux-i-mer) ,

Chemet

(trade name)

Classification

Therapeutic: antidotes
Pharmacologic: chelating agents
Pregnancy Category: C

Indications

Treatment of lead poisoning in children with blood lead levels >45 mcg/dL.

Action

Forms a water-soluble compound with lead, allowing urinary elimination of excessive amounts of lead.

Therapeutic effects

Decreased blood lead levels and decreased target organ damage in lead poisoning.

Pharmacokinetics

Absorption: Rapidly but variably absorbed following oral administration.
Distribution: Unknown.
Metabolism and Excretion: Extensively metabolized; 10% excreted unchanged by the kidneys.
Half-life: 2 days.

Time/action profile (urinary lead excretion)

ROUTEONSETPEAKDURATION
POwithin 2 hr2–4 hr8–12 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity or allergy to succimer; Lactation (should be discouraged during succimer therapy).
Use Cautiously in: Renal failure (chelates are not dialyzable); Children (increased risk of bradyarrhythmias); Children with skeletal muscle myopathy (more prone to rare, but serious, adverse reactions); Geriatric patients (use lower doses to adjust for decreased renal, hepatic and cardiac function); Pregnancy or children <1 yr (safety not established).

Adverse Reactions/Side Effects

Central nervous system

  • dizziness
  • drowsiness
  • headache

Ear, Eye, Nose, Throat

  • cloudy film in eye
  • otitis media
  • plugged ears
  • watery eyes

Respiratory

  • cough
  • nasal congestion
  • rhinorrhea
  • sore throat

Cardiovascular

  • arrhythmias

Gastrointestinal

  • nausea (most frequent)
  • vomiting (most frequent)
  • abdominal cramps
  • anorexia
  • diarrhea
  • elevated liver function tests
  • hemorrhoidal symptoms
  • metallic taste

Genitourinary

  • oliguria
  • proteinuria
  • voiding difficulty

Dermatologic

  • mucocutaneous eruptions
  • pruritus
  • rashes

Hematologic

  • eosinophilia
  • thrombocytosis

Musculoskeletal

  • back, rib, flank pain
  • leg pain

Neurologic

  • paresthesia
  • sensorimotor neuropathy

Miscellaneous

  • chills
  • fever
  • flu-like syndrome
  • moniliasis

Interactions

Drug-Drug interaction

Not recommended for use with other chelating agents.

Route/Dosage

Oral (Adults and Children) 10 mg/kg (350 mg/m2) q 8 hr for 5 days, then reduce to 10 mg/kg (350 mg/m2) q 12 hr for 2 more wk. Repeated courses should follow a 2-wk rest period.

Availability

Capsules: 100 mg

Nursing implications

Nursing assessment

  • Assess patient and family members for evidence of lead poisoning prior to and frequently throughout therapy. Acute lead poisoning is characterized by a metallic taste, colicky abdominal pain, vomiting, diarrhea, oliguria, and coma. Symptoms of chronic poisoning vary with severity and include anorexia, a blue-black line along the gums, intermittent vomiting, paresthesia, encephalopathy, seizures, and coma.
  • Monitor strict intake and output and daily weight. Notify physician or other health care professional of any discrepancies. Patients undergoing succimer therapy should be adequately hydrated.
  • Monitor neurologic status closely (level of consciousness, pupil response, movement). Notify physician or other health care professional immediately of any changes.
  • Monitor patient for signs of allergic or other mucocutaneous reactions, especially during repeated courses of succimer therapy.
  • Lab Test Considerations: Monitor blood and urine lead levels prior to and periodically throughout therapy. After therapy, monitor patients for rebound of blood levels at least once weekly until stable. Succimer is indicated for treatment of blood lead levels of >45 mcg/dL.
    • May cause elevated serum transaminases, alkaline phosphatase, and cholesterol; monitor prior to and at least weekly during therapy.
    • May interfere with serum and urine lab tests.

Potential Nursing Diagnoses

Risk for poisoning (Patient/Family Teaching)
Impaired home maintenance (Indications)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)

Implementation

  • Coadministration of succimer with other chelation agents is not recommended. Patients who have received ethylenediamine tetraacetic acid (EDTA) or dimercaprol (British anti-lewisite [BAL]) may receive subsequent therapy with succimer after 4 wk.
    • Course of treatment lasts 19 days. Doses are administered every 8 hr for 5 days and then every 12 hr for 14 days. Unless blood levels indicate prompt treatment is needed, a minimum of 2 wk between courses is recommended.
  • Oral: If patient is unable to swallow the capsule, open capsule and sprinkle medicated beads on a small amount of soft food or place in a spoon and follow with a fruit drink.

Patient/Family Teaching

  • Discuss need for follow-up appointments to monitor lead levels. Additional treatments may be necessary.
  • Instruct patient to drink adequate fluids throughout therapy.
  • Advise patient to notify health care professional if rash occurs.
  • Consult public health department regarding potential sources of lead poisoning in the home, workplace, and recreational areas. Chelation therapy cannot be used as prophylaxis for lead poisoning.

Evaluation/Desired Outcomes

  • Decrease in symptoms of lead poisoning.
    • Decrease in blood lead levels to below 45 mcg/dL, although the normal upper limit is 29 mcg/dL.

Succimer (Chemet)

A drug used to remove excess lead from the body.
Mentioned in: Lead Poisoning
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References in periodicals archive ?
Comparison of renal ultrasonography and dimercaptosuccinic acid renal scintigraphy in febrile urinary tract infection.
del Puerto Morales, "Magnetic nanoparticles coated with dimercaptosuccinic acid: development, characterization, and application in biomedicine," Journal of Nanoparticle Research, vol.
Static renal scintigraphy is based on imaging of functional renal parenchyma through the Tc-99m DMSA (dimercaptosuccinic acid) which is the radiopharmaceutical that is linked with intracellular proteins after being tubular extraction.
Technetium-99m dimercaptosuccinic acid scintigraphy studies of renal cortical scarring and renal length.
Effect of removal from lead exposure and chelation treatment with dimercaptosuccinic acid (DMSA).
Renal scars, as identified by dimercaptosuccinic acid scan, were similar in both groups.
Dimercaptosuccinic acid (DMSA; Chemet[R], Succimer[R], Succicaptal[R]), a water-soluble derivative of dimercapto-1-propanol (British Anti Lewisite), was cleared by the US Food and Drug Administration in 1991 for the treatment of children with PbB >450 [micro]g/L.
In a study of 63 such women, nearly half had renal scars, based on highly sensitive technetium--99m--labeled dimercaptosuccinic acid scanning.
Blood and bone lead levels were measured, and lead workers were given a chelator, dimercaptosuccinic acid (DMSA), so that the scientists could determine how readily lead could be removed from the body Genetic tests determined what combinations of the two variants made up the two genes within each subject.
Renal scintigraphy with dimercaptosuccinic acid (DMSA) is the reference standard for the diagnosis of acute pyelonephritis and renal scars (7,8) and was a compulsory paraclinical examination, considering that until 2010 the treatment of patients with UTI was based on the second edition of the Evidence-based Pediatric Practice Guidelines.
The left kidney has a 5% function on dimercaptosuccinic acid renal scan imaging.
All infants with UTI must be screened by ultrasonography, followed by MCU (Micturating cystourethrogram) and DMSA (Dimercaptosuccinic acid) scan.Pi On abdominal USG, 5 out of 8 boys and 1 out of 10 girls showed renal system abnormalities in our study.