Last update Nov. 26, 2024

Dimercaprol, British-Anti-Lewisite (BAL)

Likely Compatibility

Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.

Dimercaprol or British Anti-Lewisite (BAL) is a chelating agent used as an antidote in the treatment of acute poisoning by arsenic, gold, mercury, lead and other heavy metals such as antimony or bismuth. It has also been used in Wilson's disease (copper accumulation). Intramuscular administration in one or more daily doses for 10 to 15 days depending on the metal causing the intoxication.

At the date of the last update we found no published data on its excretion in breast milk.

The scarcity of known pharmacokinetic data does not allow predicting its possible passage into breast milk.

It is widely distributed in the body, but is concentrated in the kidney, liver and small intestine. Dimercaprol is rapidly metabolized and metabolites and dimercaprol metal chelates are excreted in the urine and bile. Elimination is virtually complete within 4 hours of a single dose.

Pediatric dosing is available and has been used in infants 5 months of age. (Kokori 1999)

Do not breastfeed while the mother is intoxicated, nor administer expressed milk, since the causative metals may be in breast milk and the clinical condition of the mother may not be good. Metals chelated with BAL are eliminated by urine and bile and, although it is very unlikely that they pass into milk, a prudent position would be to express and discard the milk until the levels of the causative metal are normal, in which case breast-feeding could be resumed 4 hours after the last administration of Dimecaprol.

Avoid if possible, especially if the infant is premature or less than 1 month old. Monitor infant for side-effects (haemolysis and jaundice). Avoid in G-6-PD deficient infants. (WHO 2002)

Alternatives

  • Succimer (DMSA) (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Dimercaprol, British-Anti-Lewisite (BAL) in other languages or writings:

Group

Dimercaprol, British-Anti-Lewisite (BAL) belongs to this group or family:

Pharmacokinetics

Variable Value Unit
Molecular weight 124 daltons
Tmax 0.5 - 1 hours
< 1 hours

References

  1. Dawn L, Whited L. Dimercaprol.. 2023 Aug 28. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Abstract Full text (link to original source)
  2. WHO / UNICEF. BREASTFEEDING AND MATERNAL MEDICATION Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs. Department of Child and Adolescent Health and Development (WHO/UNICEF) 2002 Abstract Full text (link to original source) Full text (in our servers)
  3. Kokori H, Giannakopoulou CH, Hatzidaki E, Athanaselis S, Tsatsakis A, Sbyrakis S. An unusual case of lead poisoning in an infant: nursing-associated plumbism. J Lab Clin Med. 1999 Nov;134(5):522-5. Abstract

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