| U.S. Brand Names |
| BAL in Oil® |
 |
| Generic Available |
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No |
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| Synonyms |
| BAL; British Anti-Lewisite; Dithioglycerol |
|
| Pharmacological Index |
|
Antidote |
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| Use |
|
Antidote to gold, arsenic (except arsine), and mercury poisoning (except nonalkyl mercury); adjunct to edetate calcium disodium in lead poisoning; possibly effective for antimony, bismuth, chromium, copper, nickel, tungsten, or zinc |
|
| Pregnancy Risk Factor |
|
C |
|
| Contraindications |
|
Hepatic insufficiency (unless due to arsenic poisoning); do not use on iron, cadmium, or selenium poisoning |
|
| Warnings/Precautions |
|
Potentially a nephrotoxic drug, use with caution in patients with oliguria or glucose 6-phosphate dehydrogenase deficiency; keep urine alkaline to protect kidneys; administer all injections deep I.M. at different sites |
|
| Adverse Reactions |
|
>10%: Cardiovascular: Hypertension, tachycardia (dose-related) Central nervous system: Headache 1% to 10%: Gastrointestinal: Nausea, vomiting <1%: Nervousness, fever, convulsions, salivation, transient neutropenia, thrombocytopenia, increased PT, pain at the injection site, abscess formation, myalgia, paresthesia, blepharospasm, burning eyes, nephrotoxicity, dysuria, burning sensation of the lips, mouth, throat, and penis |
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| Drug Interactions |
|
Toxic complexes with iron, cadmium, selenium, or uranium |
|
| Stability |
|
Do not mix in the same syringe with edetate calcium disodium |
|
| Mechanism of Action |
|
Sulfhydryl group combines with ions of various heavy metals to form relatively stable, nontoxic, soluble chelates which are excreted in urine |
|
| Pharmacodynamics/Kinetics |
|
Distribution: Distributes to all tissues including the brain Metabolism: Rapidly to inactive products Time to peak serum concentration: 0.5-1 hour Elimination: In urine |
|
| Usual Dosage |
|
Children and Adults: Deep I.M.: Lead poisoning (in conjunction with calcium EDTA): For symptomatic acute encephalopathy or blood level >100 mcg/dL: 4-5 mg/kg every 4 hours for 3-5 days |
|
| Administration |
|
Administer deep I.M. only |
|
| Test Interactions |
|
Iodine 131I thyroidal uptake values may be decreased |
|
| Mental Health: Effects on Mental Status |
|
May cause nervousness |
|
| Mental Health: Effects on Psychiatric Treatment |
|
May produce neutropenia; use caution with clozapine and carbamazepine |
|
| Dental Health: Local Anesthetic/Vasoconstrictor Precautions |
|
No information available to require special precautions |
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| Dental Health: Effects on Dental Treatment |
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No effects or complications reported |
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| Patient Information |
|
Frequent blood and urine tests may be required |
|
| Nursing Implications |
|
Urine should be kept alkaline because chelate dissociates in acid media |
|
| Dosage Forms |
|
Injection: 100 mg/mL (3 mL) |
|
| References |
|
Cantilena LR Jr and Klaassen CD, "The Effect of Chelating Agents on the Excretion of Endogenous Metals," Toxicol Appl Pharmacol, 1982, 63(3):344-50. Kosnett MJ, "Unanswered Questions in Metal Chelation," J Toxicol Clin Toxicol, 1992, 30(4):529-47. "Treatment Guidelines for Lead Exposure in Children. American Academy of Pediatrics Committee on Drugs," Pediatrics, 1995, 96(1 Pt 1):155-60. |
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