Table 1 Overview of chelation drugs

2,3-bis(sulfanyl)butanedioic acid (Dimercaptosuccinic acid; DMSA; Succimer)

10 mg/kg (or 350 mg/m²) per 8 h for 5 days, then 10 mg/kg per 12 h for 14 days (a total of 19 days), PO^a.

Gastrointestinal disturbances, mild increase in serum transaminase

Lead, arsenic, mercury, cadmium, silver, tin, copper

Sodium 2,3-bis(sulfanyl)propane-1-sulfonate (Dimercaptopropanesulfonate; DMPS; Dimaval)

Adult: 5 mg/kg per 6–8 h, PO, IM^b, IV^c, or SQ^d.

Low back (kidney) pain, gastrointestinal disturbances, skin rash, fatigue, hypersensitivity reactions

Mercury, arsenic, lead, cadmium, tin, silver, copper, selenium, zinc, magnesium

Children: 5-day course of 200 or 400 mg/m²/day

2-[2-[bis(carboxymethyl)amino]ethyl-(carboxymethyl)amino]acetic acid (Ethylenediaminetetraacetic acid; EDTA; CaNa₂EDTA)

1000–1500 mg/m²/day (1–2 g/24 h for a 70-kg adult) as an IV infusion for 5 days

Renal toxicity

Lead, cadmium, zinc

(2S)-2-amino-3-methyl-3-sulfanylbutanoic acid (3-Sulfanyl-D-valine; Penicillamine; D- Penicillamine)

10 mg/kg/day for 7 days with a possibility of a prolonged treatment during 2 to 3 weeks, PO.

Interstitial nephritis, hypersensitivity reactions, gastrointestinal disturbances, leukopenia and thrombocytopenia

Copper, arsenic, zinc, mercury, lead

2,3-bis(sulfanyl)propan-1-ol (Dimercaprol; British Anti-Lewisite; BAL)

50–75 mg/m² per 4 h for 5 days, deep IM.

Allergy, gastrointestinal symptoms, tachycardia, fever, elevation of liver function tests

Arsenic, gold, mercury, lead (BAL in combination with CaNa₂EDTA)