Succimer

CHEMET

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Succimer ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Succimer ballicule

What it isOral dithiol chelator for lead poisoning in children with blood lead levels above 45 mcg/dL.

Why this oneAllows outpatient oral chelation for moderate lead poisoning and causes less essential-metal loss than calcium disodium EDTA.

What limits itIt does not cross the blood-brain barrier or treat lead encephalopathy; remove the exposure source and monitor for rebound lead levels, neutropenia, and transaminitis.

Succimer molecular structure (skeletal formula) — Molecular structure: Succimer

FDA label

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FDA dosing	Population	Start	Target	Max
Lead poisoning	Pediatric	10 mg/kg or 350 mg/m² q8h (TID) ×5 days	then 10 mg/kg or 350 mg/m² q12h (BID) ×14 days

Renal Assess renal function (BUN/creatinine/urinary protein) before treatment; succimer and lead are renally excreted.

Hepatic Monitor AST/ALT at baseline and weekly; reduce/interrupt if elevations >5× ULN.

Total 19-day course; minimum 2 weeks between repeat courses; dosing >3 weeks not established.

Instructions

Ensure adequate hydration.
Swallow capsules whole when possible; for patients who cannot, sprinkle contents on food or a spoon followed by a drink.
Interrupt for neutropenia (ANC <1200/mcL); resume when ANC >1500/mcL.

Available strengths

cap 100 mg
inj 1 mg

Cautions

Hypersensitivity and dermatologic reactions (rash, mucocutaneous vesicular eruptions) — interrupt treatment
Neutropenia — monitor CBC weekly
Hepatic toxicity — monitor transaminases
Embryo-fetal toxicity — use effective contraception
Interference with serum/urinary laboratory tests

Adverse reactions

GI: nausea, vomiting, diarrhea, appetite loss, hemorrhoidal symptoms, metallic taste
Elevated ALT/AST
Rash / mucocutaneous eruptions
Drowsiness, dizziness
Neutropenia

Pregnancy May cause fetal harm (animal data); use only if benefit justifies risk; use contraception during and 14 days after.

Lactation No data on presence in milk; women with blood lead ≥40 mcg/dL should not breastfeed.

Cost

Succimer (CHEMET)

Strength		#/mo	generic $/unit	CostPlus
100 mg	cap	per unit		not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Succimer is dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

Generic entryNo US generic

NO BOXED WARNINGS

Principal riskneutropenia; monitor CBC and interrupt if ANC falls below 1,200/mcL

Classes and tags

Clinical profile

Therapeutic safety burden1 / 4

Overdose danger1 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk1 / 4

Legacy pregnancy categoryUnknown / historical label unavailable

Defining liabilityAllergic, renal or procedure-related complications vary by diagnostic agent and route.

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