Succimer

(BAN, USAN, rINN)
Synonyms: DIM-SA; DMSA; Succimère; Succímero; Succimero; Succimerum; Suksimeeri. meso-2,3-Dimercaptosuccinic acid; (R * ,S * )2,3-Dimercapto-butanedioic acid.
Cyrillic synonym: Сукцимер.

💊 Chemical information

Chemical formula: C4H6O4S2 = 182.2.
CAS — 304-55-2.

Pharmacopoeias.

In Chin.

💊 Adverse Effects and Precautions

Succimer may cause gastrointestinal disorders, skin rashes, increases in serum transaminase, flu-like symptoms, drowsiness, and dizziness. Mild to moderate neutropenia has been reported in some patients and regular full blood counts are recommended during therapy. Succimer should be used with caution in patients with renal impairment or a history of hepatic disease.

💊 Pharmacokinetics

Succimer is rapidly but incompletely absorbed after oral doses. It undergoes rapid and extensive metabolism and is excreted mainly in the urine with small amounts excreted in the bile and via the lungs.
1. Dart RC, et al. Pharmacokinetics of meso-2,3-dimercaptosuccinic acid in patients with lead poisoning and in healthy adults. J Pediatr 1994; 125: 309–16.

💊 Uses and Administration

Succimer is a chelator structurally related to dimercaprol. It forms water-soluble chelates with heavy metals and is used in the treatment of lead poisoning. It has also been used in the treatment of poisoning with arsenic or mercury. Succimer, labelled with a radionuclide, is used in nuclear medicine. In the treatment of lead poisoning, succimer is given orally in a dose of 10 mg/kg or 350 mg/m 2 every 8 hours for 5 days then every 12 hours for an additional 14 days. The course of treatment may be repeated if necessary, usually after an interval of not less than 2 weeks.

Lead poisoning.

Succimer is an effective lead chelator1 and is used in the management of lead poisoning. Succimer is also used in children with chronic lead exposure, and various dosage regimens have been studied.2 It is generally only indicated if blood-lead concentrations are greater than 45 micrograms per 100 mL;3 although short-term studies4 in children with lower concentrations have shown effective reduction of blood lead, no effect on neurodevelopmental outcome has been shown in follow-up studies5,6 and treatment of such children remains controversial.
1. Mann KV, Travers JD. Succimer, an oral lead chelator. Clin Pharm 1991; 10: 914–22
2. Farrar HC, et al. A comparison of two dosing regimens of succimer in children with chronic lead poisoning. J Clin Pharmacol 1999; 39: 180–3
3. American Academy of Pediatrics Committee on Environmental Health. Lead exposure in children: prevention, detection, and management. Pediatrics 2005; 116: 1036–46. Also available at: http://pediatrics.aappublications.org/cgi/reprint/116/4/1036 (accessed 11/10/05
4. Besunder JB, et al. Short-term efficacy of oral dimercaptosuccinic acid in children with low to moderate lead intoxication. Pediatrics 1995; 96: 683–7
5. Rogan WJ, et al. The effect of chelation therapy with succimer on neuropsychological development in children exposed to lead. N Engl J Med 2001; 344: 1421–6
6. Dietrich KN, et al. Effect of chelation therapy on the neuropsychological and behavioral development of lead-exposed children after school entry. Pediatrics 2004; 114: 19–26.

Mercury poisoning.

Succimer, given orally, increases the renal excretion of mercury and may be used in mercury poisoning. In patients with renal impairment, the succimer-mercury chelate may accumulate, and alternative methods have been tried. Extracorporeal infusion of succimer into the arterial blood line during haemodialysis, a procedure known as extracorporeal regional complexing haemodialysis, produced a substantial clearance of mercury in an anuric patient following intoxication with inorganic mercury.1 Clearance was about ten times greater than that achieved with haemodialysis after intramuscular dimercaprol.
1. Kostyniak PJ, et al. Extracorporeal regional complexing haemodialysis treatment of acute inorganic mercury intoxication. Hum Toxic ol 1990; 9: 137–41.

💊 Preparations

Proprietary Preparations

Fr.: Succicaptal; USA: Chemet.
Published December 31, 2018.