Drug Guide
Succimer
Classification
Therapeutic: Heavy metal detoxification
Pharmacological: Chelating agent
FDA Approved Indications
- Lead poisoning in children and adults
Mechanism of Action
Succimer binds to lead in blood and tissues, forming stable complexes that are excreted in the urine, thereby reducing lead levels in the body.
Dosage and Administration
Adult: Initial dose: 10 mg/kg orally every 8 hours for 5 days, then 10 mg/kg every 12 hours for an additional 14 days if needed.
Pediatric: Same as adults, based on body weight, typically 10 mg/kg every 8 hours for 5 days, then 10 mg/kg every 12 hours for up to 14 days.
Geriatric: Use with caution; dosage adjustments based on renal function may be necessary.
Renal Impairment: Adjust doses based on renal function; close monitoring recommended.
Hepatic Impairment: No specific adjustments indicated.
Pharmacokinetics
Absorption: Rapid, well-absorbed orally.
Distribution: Widely distributed in tissues.
Metabolism: Minimal metabolism; excreted largely unchanged.
Excretion: Primarily via urine, as chelate complexes.
Half Life: Approximately 3 hours.
Contraindications
- Hypersensitivity to succimer or any component of the formulation.
Precautions
- Use with caution in patients with renal impairment; monitor renal function; pregnancy categoryB; lactation: consult healthcare provider.
Adverse Reactions - Common
- Gastrointestinal upset (nausea, vomiting, diarrhea) (Common)
- Rash or itching (Less common)
Adverse Reactions - Serious
- Nephrotoxicity or renal impairment (Rare)
- Allergic reactions, including rash, urticaria, or angioedema (Rare)
Drug-Drug Interactions
- Calcium supplements (may interfere with chelation)
Drug-Food Interactions
- No significant interactions reported
Drug-Herb Interactions
- Limited data, use caution with herbal supplements
Nursing Implications
Assessment: Monitor blood lead levels, renal function, and signs of hypersensitivity.
Diagnoses:
- Risk for renal impairment
- Ineffective tissue perfusion related to heavy metal toxicity
Implementation: Administer as prescribed; encourage hydration to facilitate urinary excretion.
Evaluation: Assess decrease in blood lead levels, monitor for adverse reactions, renal function.
Patient/Family Teaching
- Take medication exactly as prescribed.
- Report any allergic reactions or side effects.
- Maintain hydration during therapy.
- Follow-up blood lead level testing required.
Special Considerations
Black Box Warnings: N/A
Genetic Factors: None noted.
Lab Test Interference: May affect lead blood level testing; coordinate with laboratory.
Overdose Management
Signs/Symptoms: Nausea, vomiting, abdominal pain, and possible nephrotoxicity.
Treatment: Supportive care; symptomatic treatment; dialysis if severe renal impairment.
Storage and Handling
Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F); protect from moisture.
Stability: Stable under recommended storage conditions.