Medical uses[ edit ] Dimercaprol has long been the mainstay of chelation therapy for lead or arsenic poisoning,  and it remains an essential drug. Nonetheless, because it can have serious adverse effects , researchers have also pursued development of less toxic analogues. Other drawbacks include the need to administer it by painful intramuscular injection. Dimercaprol has been found to form stable chelates in vivo with many other metals including inorganic mercury , antimony , bismuth , cadmium , chromium , cobalt , gold , and nickel.
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Lorincz of the University of Michigan has no relevant financial relationships to disclose. Originally released November 30, ; last updated March 13, ; expires March 13, Introduction Overview British anti-Lewisite was developed in as an antidote to lewisite, an arsenic-based chemical warfare agent. British anti-Lewisite is used in arsenic, gold, and mercury soluble inorganic compounds poisoning. This drug is not indicated in patients with iron, cadmium, selenium, silver, or uranium poisoning.
British anti-Lewisite is occasionally used for both acute heavy metal intoxication and Wilson disease. Parenteral British anti-Lewisite can be successfully used in lead poisoning if oral therapy fails. Dimercaprol compound is useful for the treatment of potentially life-threatening acute arsenic poisoning as well. Mobilization of cerebral deposits of mercury is difficult to achieve.
A combination of low-dosed British anti-Lewisite plus dimercaptopropane sulfonic acid can help in mobilizing the intracerebral mercury into the circulation, thus, facilitating urinary excretion. Historical note and terminology Lewisite 2-chlorovinyldichoroarsine is an arsenic-based vesicant chemical warfare agent that was initially developed, although not used, by the United States during World War I.
It was believed to have much greater toxicity than mustard gas, with some animal data suggesting that as little as one-third teaspoon on the skin would result in human death Vilensky On July 21, , an Oxford University group of chemists reported the successful development of British anti-Lewisite Ord On first arrival in the United States in , a series of studies was initiated to determine British anti-Lewisite s biochemistry, pharmacology, experimental therapeutics, and clinical applications Waters and Stock Improvements in synthesis resulted in the development of effective therapeutic ointments and solutions.
Plans for the possible production of , pounds per year were developed Waters and Stock During and after the war, nonmilitary uses for the heavy metal chelating action of British anti-Lewisite became apparent.
Eagle and Magnuson found that 48 patients with severe or mild symptoms of arsenical encephalopathy were effectively treated with British anti-Lewisite Eagle and Magnuson By , 32 articles had been published or were in press on the therapeutic value of British anti-Lewisite Ord British anti-Lewisite was the drug of choice for treatment of intoxication with arsenic, antimony, mercury, and gold. It was also considered effective in cases of intoxication with bismuth, copper, and nickel Deichmann and Gerarde In , Porter found a 7-fold increase in copper excretion in 2 patients with Wilson disease and some decrease in neurologic signs after treatment with British anti-Lewisite Porter The effects were definitive and dramatic; the patients exhibited great improvement in accordance with marked increases in urinary copper excretion Cummings ; Denny-Brown and Porter British anti-Lewisite s use as the primary treatment for Wilson disease was short-lived because Walshe, in , showed the value of the less toxic chelating agent, penicillamine Walshe Other agents have been developed since Brewer Nevertheless, British anti-Lewisite may still have some therapeutic value in patients who do not respond well to more modern agents Scheinberg and Sternlieb It has been postulated that, because British anti-Lewisite is nonpolar, it may accelerate the removal of copper from within the brain compared to more modern agents Scheimberg and Sternlieb ; Walshe British anti-Lewisite is not generally recommended for use today because more efficient and safer chelators for oral or parenteral administration have been developed Andersen ; Blanusa et al ; Archer In This Article.
Removal of patient from exposure is the primary therapy for exposed patients. The toxic metal ion is inactivated and its incorporation into binding sites in blood and tissue is prevented. If reactivation of enzymes is necessary, prolonged therapy may be required. This maintains a plasma concentration of free dimercaprol in the body fluids that enhances the continuous formation of a rapidly excreted stable complex of dimercaprol:metal until a significant portion of the metal is eliminated from the body. If patients are placed on parenteral fluids, adjustment of the composition of the solutions may provide a neutral urine, or alkalization of the urine may be achieved by intravenous infusion of sodium bicarbonate over 4 to 8 hours. Such patients may be advanced cautiously to clear oral liquids or oral rehydration solutions.
British anti-Lewisite (dimercaprol): an amazing history.