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Succimer: the first approved oral lead chelator

F M Jorgensen1

  • 1Fairview General Hospital, Cleveland, Ohio.

American Family Physician
|December 1, 1993
PubMed
Summary

The Centers for Disease Control and Prevention lowered the lead toxicity concern level to 10 micrograms per dL, recommending universal screening for children. Succimer is an oral chelating agent for lead poisoning, with generally mild side effects and requiring regular monitoring.

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Area of Science:

  • Pediatric Environmental Health
  • Toxicology
  • Pharmacology

Background:

  • The Centers for Disease Control and Prevention (CDC) has revised the reference value for concern regarding lead toxicity in children.
  • The new threshold for concern is now 10 micrograms per deciliter (µg/dL), a significant reduction from the previous 25 µg/dL.
  • Universal screening for young children is now recommended due to this redefinition.

Purpose of the Study:

  • To review the efficacy and safety of succimer (2,3-dimercaptosuccinic acid) as an oral lead chelating agent.
  • To discuss clinical experience and management strategies for children undergoing succimer treatment for lead toxicity.
  • To highlight the importance of monitoring during succimer therapy.

Main Methods:

  • Review of clinical experience with succimer in the United States.
  • Analysis of reported side effects and adverse events associated with succimer treatment.
  • Description of recommended monitoring protocols, including blood lead levels, complete blood counts, and serum aminotransferase levels.

Main Results:

  • Succimer is an effective oral chelating agent approved for treating children with blood lead levels above 45 µg/dL.
  • Observed side effects are generally uncommon and mild, including gastrointestinal symptoms, rash, and transient elevations in serum aminotransferase levels.
  • Isolated cases of neutropenia have been reported, necessitating careful monitoring.

Conclusions:

  • Succimer offers a viable oral treatment option for lead toxicity in children.
  • Regular monitoring of blood counts and liver enzymes is crucial during the 19-day treatment course.
  • Monitoring blood lead levels is essential to detect potential rebound after chelation therapy.

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