Usual Pediatric Dose for Lead Poisoning - Severe

1 year or older:
Initial dose: 10 mg/kg or 350 mg/m2 orally every 8 hours for five days
Maintenance dose: 10 mg/kg or 350 mg/m2 orally every 12 hours for 14 days

8 kg to 15 kg:
Initial dose: 100 mg orally every 8 hours for five days
Maintenance dose: 100 mg orally every 12 hours for 14 days

16 kg to 23 kg:
Initial dose: 200 mg orally every 8 hours for five days
Maintenance dose: 200 mg orally every 12 hours for 14 days

24 kg to 34 kg:
Initial dose: 300 mg orally every 8 hours for five days
Maintenance dose: 300 mg orally every 12 hours for 14 days

35 kg to 44 kg:
Initial dose: 400 mg orally every 8 hours for five days
Maintenance dose: 400 mg orally every 12 hours for 14 days

45 kg or greater:
Initial dose: 500 mg orally every 8 hours for five days
Maintenance dose: 500 mg orally every 12 hours for 14 days

Comments:

• Do not use for prophylaxis of lead poisoning in a lead-containing environment.
• Always identify and remove the source of the lead exposure.
• May repeat courses if indicated by weekly blood lead concentration levels, with a minimum of two weeks between courses unless blood lead levels necessitate more rapid treatment.

Renal Dose Adjustments

Use with caution.

Liver Dose Adjustments

Data not available

• Close monitoring is recommended for patients with a history of liver disease.

Dose Adjustments

Neutropenia:

• Withhold or discontinue if absolute neutrophil count (ANC) falls below 1200/mcL; follow patient closely until recovery of ANC to over 1500/mcL or the patients baseline level.
• Due to limited experience with re-exposure in patients who experienced neutropenia, use this drug only if therapy clearly outweighs the risk of another neutropenic episode and monitor the patient closely.

Precautions

CONTRAINDICATIONS:

• Hypersensitivity to the drug

Dialysis

Data not available

• Limited data suggests succimer is dialyzable, but not the lead chelates.

Other Comments

Administration advice:

• The capsule may be opened, and the contents administered on a small amount of food for those unable to swallow the capsules.

• Neutropenia has been reported with drugs in this chemical class.

• A complete blood count, including white blood cell differential and direct platelet counts should be performed prior to therapy and weekly during treatment, also if infection is suspected.
• Withhold or discontinue if absolute neutrophil count (ANC) falls below 1200/mcL; follow patient closely until recovery of ANC to over 1500/mcL or the patients baseline level.
• Due to limited experience with re-exposure in patients who experienced neutropenia, use this drug only if therapy clearly outweighs the risk of another neutropenic episode and monitor the patient closely.

• Advise patients to report signs of infection promptly.
• Advise patients to maintain adequate fluid intake.