BAL In Oil

Name: BAL In Oil

What should I discuss with my health care provider before receiving BAL In Oil (dimercaprol)?

If possible before you receive dimercaprol, tell your doctor if you have:

  • liver or kidney disease;

  • an allergy to any drugs; or

  • if you are pregnant or breast-feeding.

This medicine contains peanut oil. Tell your doctor if you have a peanut allergy.

FDA pregnancy category C. It is not known whether dimercaprol will harm an unborn baby. Tell your doctor if you are pregnant.

It is not known whether dimercaprol passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

In an emergency situation, it may not be possible before you are treated with dimercaprol to tell your caregivers if you are pregnant or breast-feeding. However, make sure any doctor caring for your pregnancy or your baby knows that you have received this medicine.

BAL in Oil Dosage and Administration

General

  • Administer at earliest possible time and at adequate doses at frequent intervals for greatest efficacy;a b should always be accompanied by appropriate supportive measures.a b

  • Consult published protocols and specialized references for dosages of chelating agents, the method and sequence of administration, and specific information on precautions associated with chelation therapy.a i

  • Maintain alkaline urine during therapy to prevent dissociation of dimercaprol-metal complex and protect the kidneys.105 b f h (See Renal Effects under Cautions.)

    Lead Poisoning
  • Various dosage regimens have been recommended in lead poisoning management;i total dose of chelator depends on patient’s response to, and tolerance of, the select agent,i as well as severity of lead toxicity.i

  • When source for lead poisoning has been identified, remove patient from that source.102 103 104 g

  • Chelation therapy can increase absorption of lead from the GI tract; therefore, administer only to patients who reside in environments free of lead both during and after therapy.102 104

  • Administer in hospital setting; monitor cardiovascular and mental status closely.103 g

  • Subsequent course(s) of therapy may be required based on clinical symptoms and blood lead concentrations.g In patients with severe lead poisoning, allow ≥2 days without treatment to elapse before a second 5-day course of therapy is considered.103 Assess blood lead concentrations 10–14 days after completion of chelation therapy to allow reequilibration.103 g

Administration

Administer by deep IM injection.a b

Has also been administered topically† as a 5% ointment for dermatologic manifestations of arsenic poisoning or as a 5–10% oil solution for ocular manifestations of arsenic poisoning.a

IM Administration

Administer by deep IM injection.a b

Consider prophylactic or therapeutic administration of antihistamines to prevent or relieve mild adverse effects.103 a b

Dosage

Pediatric Patients

Arsenic or Gold Poisoning Mild Arsenicor Gold Poisoning IM

2.5 mg/kg 4 times daily for 2 days; then 2.5 mg/kg twice daily on the third day; then 2.5 mg/kg once daily thereafter for 10 days.a b

Severe Arsenicor Gold Poisoning IM

3 mg/kg every 4 hours for 2 days; then 3 mg/kg 4 times daily on the third day; then 3 mg/kg twice daily thereafter for 10 daysa b or until recovery is complete.a

Severe Gold Dermatitis IM

2.5 mg/kg every 4 hours for 2 days, then 2.5 mg/kg twice daily for about 1 week.a

Mercury Poisoning IM

Initially, 5 mg/kg.a b Then 2.5 mg/kg once or twice daily for 10 days.a b

Mercury-induced Acrodynia IM

Infants and children: 3 mg/kg every 4 hours for 2 days, then 3 mg/kg every 6 hours for 1 day, then 3 mg/kg every 12 hours for 7–8 days.a

Lead Poisoning

Consult most recent published protocols, including those from AAP and CDC, and specialized references for combination therapy dosage recommendations.i

Lead Encephalopathy IM

Initially, 4 mg/kga b g or 75 mg/m2.f g Then, at least 4 hours latera (and when adequate urine flow established) begin 4 mg/kga b or 75 mg/m2f g every 4 hours (i.e., 450 mg/m2 daily),g in conjunction with edetate calcium disodium (administered at separate injection sites), a b for at least 3 days (usual duration is 5 days).a f g

Decision to repeat dual therapy should be based on clinical symptoms and blood lead concentrations.g

Symptoms Suggestive of Encephalopathy or Blood Lead Concentration >70 mcg/dL IM

Initially, 3–4 mg/kgg or 50–75 mg/m2.a Then, at least 4 hours latera (and when adequate urine flow established) begin 3–4 mg/kgb g or 50–75 mg/m2g every 4 hours (i.e., 300–450 mg/m2 daily),g in conjunction with edetate calcium disodium (administered at separate injection sites),a b for 3–5 days.a f g

Decision to repeat dual therapy should be based on clinical symptoms and blood lead concentrations.g

Chemical Warfare Agent Poisoning Lewisite or Mustard-lewisite Mixture Poisoning† IM

3–5 mg/kg every 4 hours for 4 doses.105 Adjust dosage regimen based on extent of exposure and severity of symptoms.105

Adults

Consult most recent published protocols, including those from AAP and CDC, and specialized references for combination therapy dosage recommendations.a i

Arsenic or Gold Poisoning Mild Arsenic or Gold Poisoning IM

2.5 mg/kg 4 times daily for 2 days; then 2.5 mg/kg twice daily on the third day; then 2.5 mg/kg once daily thereafter for 10 days.a b

Severe Arsenic or Gold Poisoning IM

3 mg/kg every 4 hours for 2 days; then 3 mg/kg 4 times daily on the third day; then 3 mg/kg twice daily thereafter for 10 daysa b or until recovery is complete.a

Alternatively, for severe arsenic poisoning, 3 mg/kg every 4 hours for 2 days and then 3 mg/kg twice daily thereafter for 7–10 daysf or 3–5 mg/kg every 4–6 hours for 1 day and then taper dose and frequency, depending on patient’s symptoms.f

Severe Gold Dermatitis IM

2.5 mg/kg every 4 hours for 2 days, then 2.5 mg/kg twice daily for about 1 week.a

Gold-induced Thrombocytopenia IM

100 mg twice daily for 15 days.a

Mercury Poisoning IM

Initially, 5 mg/kg.a b Then 2.5 mg/kg once or twice daily for 10 days.a b

Alternatively, 5 mg/kg initially and then 2.5 mg/kg every 8–12 hours for 1 day, followed by 2.5 mg/kg every 12–24 hours until patient improves, up to a total of 10 days;f or 5 mg/kg every 4 hours for 48 hours, then 2.5 mg/kg every 6 hours for 48 hours, then 2.5 mg/kg every 12 hours for 7 days (total of 10 days).j

Lead Poisoning

Consult most recent published protocols, including those from AAP and CDC, and specialized references for combination therapy dosage recommendations.a

Lead Encephalopathy IM

Initially, 4 mg/kga b g or 75 mg/m2.g Then, at least 4 hours later (and when adequate urine flow established) begin 4 mg/kga b or 75 mg/m2g every 4 hours (i.e., 450 mg/m2 daily),g in conjunction with edetate calcium disodium (administered at separate injection sites), a b for at least 3 days (usual duration is 5 days).a

Decision to repeat dual therapy should be based on clinical symptoms and blood lead concentrations.g

Symptoms Suggestive of Encephalopathy or Blood Lead Concentration >100 mcg/dL IM

Initially, 3–4 mg/kgg or 50–75 mg/m2.a Then, at least 4 hours later (and when adequate urine flow established) begin 3–4 mg/kgb g or 50–75 mg/m2g every 4 hours (i.e., 300–450 mg/m2 daily),g in conjunction with edetate calcium disodium (administered at separate injection sites),a b for at least 3–5 days.a f g

Decision to repeat dual therapy should be based on clinical symptoms and blood lead concentrations.g

Chemical Warfare Agent Poisoning Lewisite or Mustard-lewisite Mixture Poisoning† IM

3–5 mg/kg every 4 hours for 4 doses.105 Adjust dosage regimen based on extent of exposure and severity of symptoms.105

Special Populations

No special population dosage recommendations at this time.b

Interactions for BAL in Oil

Specific Drugs

Drug

Interaction

Comments

Iron-containing preparations

Dimercaprol forms a toxic complex with iron103 a

Do not give iron concurrently with dimercaprol; defer iron therapy ≥24 hours after last dimercaprol dosea b

Stability

Storage

Parenteral

Solution for IM Injection

20–25°C.b

Contraindications

BAL in Oil (Dimercaprol Injection USP) is contraindicated in most instances of hepatic insufficiency with the exception of postarsenical jaundice. The drug should be discontinued or used only with extreme caution if acute renal insufficiency develops during therapy.

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