Usual Adult Dose for Lead Poisoning - Mild

For asymptomatic adult patients whose blood lead level is < 70 mcg/dL but > 20 mcg/dL (World Health Organization recommended upper allowable level):
1000 mg/m2/day given intravenously or intramuscularly
Duration of therapy: 5 days; allow 2 to 4 days for lead redistribution and to prevent severe depletion of zinc and other essential metals

• Two courses of treatment are usually employed, depending on severity of lead toxicity and patient tolerance of treatment.

Blood lead level over 70 mcg/dL: Use in conjunction with BAL (dimercaprol) is recommended

• Consult published protocols and specialized references for combination therapy dosage recommendations.

Comments:

• Chelation should not replace effective measures to eliminate or reduce further lead exposure.
• Remove patient from source of lead intoxication if identified.
• The manufacturer product information should be consulted for a surface area nomogram.

Use(s): Reduction of blood levels and depot stores of lead in lead poisoning (acute and chronic) and lead encephalopathy

Usual Adult Dose for Lead Poisoning - Severe

For asymptomatic adult patients whose blood lead level is < 70 mcg/dL but > 20 mcg/dL (World Health Organization recommended upper allowable level):
1000 mg/m2/day given intravenously or intramuscularly
Duration of therapy: 5 days; allow 2 to 4 days for lead redistribution and to prevent severe depletion of zinc and other essential metals

• Two courses of treatment are usually employed, depending on severity of lead toxicity and patient tolerance of treatment.

Blood lead level over 70 mcg/dL: Use in conjunction with BAL (dimercaprol) is recommended

• Consult published protocols and specialized references for combination therapy dosage recommendations.

Comments:

• Chelation should not replace effective measures to eliminate or reduce further lead exposure.
• Remove patient from source of lead intoxication if identified.
• The manufacturer product information should be consulted for a surface area nomogram.

Use(s): Reduction of blood levels and depot stores of lead in lead poisoning (acute and chronic) and lead encephalopathy

Usual Pediatric Dose for Lead Poisoning - Mild

For asymptomatic pediatric patients whose blood lead level is < 70 mcg/dL but > 20 mcg/dL (World Health Organization recommended upper allowable level):
1000 mg/m2/day given intravenously or intramuscularly
Duration of therapy: 5 days; allow 2 to 4 days for lead redistribution and to prevent severe depletion of zinc and other essential metals

• Two courses of treatment are usually employed, depending on severity of lead toxicity and patient tolerance of treatment.

Blood lead level over 70 mcg/dL: Use in conjunction with BAL (dimercaprol) is recommended

• Consult published protocols and specialized references for combination therapy dosage recommendations.

Comments:

• Chelation should not replace effective measures to eliminate or reduce further lead exposure.
• Remove patient from source of lead intoxication if identified.
• The manufacturer product information should be consulted for a surface area nomogram.

Use(s): Reduction of blood levels and depot stores of lead in lead poisoning (acute and chronic) and lead encephalopathy

Usual Pediatric Dose for Lead Poisoning - Severe

For asymptomatic pediatric patients whose blood lead level is < 70 mcg/dL but > 20 mcg/dL (World Health Organization recommended upper allowable level):
1000 mg/m2/day given intravenously or intramuscularly
Duration of therapy: 5 days; allow 2 to 4 days for lead redistribution and to prevent severe depletion of zinc and other essential metals

• Two courses of treatment are usually employed, depending on severity of lead toxicity and patient tolerance of treatment.

Blood lead level over 70 mcg/dL: Use in conjunction with BAL (dimercaprol) is recommended

• Consult published protocols and specialized references for combination therapy dosage recommendations.

Comments:

• Chelation should not replace effective measures to eliminate or reduce further lead exposure.
• Remove patient from source of lead intoxication if identified.
• The manufacturer product information should be consulted for a surface area nomogram.

Use(s): Reduction of blood levels and depot stores of lead in lead poisoning (acute and chronic) and lead encephalopathy

Renal Dose Adjustments

Pre-existing mild renal disease: Use in reduced doses

For adults with lead nephropathy the following dosing regimen has been suggested.

Serum creatinine 2 to 3 mg/dL:
500 mg/m2 every 24 hours for 5 days

Serum creatinine 3 to 4 mg/dL:
500 mg/m2 every 48 hours for 3 doses

Serum creatinine above 4 mg/dL:
500 mg/m2 once weekly

These regimens may be repeated at one month intervals.

Liver Dose Adjustments

Contraindicated in active hepatitis

Precautions

US BOXED WARNING(S):

• This drug can produce toxic effects which can be fatal.
• Lead encephalopathy is rare in adults; it occurs more often in pediatric patients in whom it may be incipient and thus overlooked.
• The mortality rate in pediatric patients has been high.
• Patients with lead encephalopathy and cerebral edema may experience a lethal increase in intracranial pressure after intravenous infusion; intramuscular injection is preferred for these patients.
• In cases where the IV route is necessary, avoid rapid infusion.
• At no time should the recommended daily dose by exceeded; follow the dosage schedule.

Consult WARNINGS section for additional precautions.

Dialysis

No data available

Other Comments

Administration advice:

• IV or intramuscular administration are equally effective; the intramuscular route is preferred by some for young pediatric patients.
• Patients with lead encephalopathy and cerebral edema may experience a lethal increase in intracranial pressure after intravenous infusion; intramuscular injection is preferred for these patients.
• In cases where the IV route is necessary, avoid rapid infusion.
• At no time should the recommended daily dose by exceeded; follow the dosage schedule.
• Establish urine flow prior to the first dose, as this drug is eliminated almost exclusively in the urine; however avoid excessive fluid in patients with encephalopathy.