BAL in Oil, British Anti-Lewisite
Classifications: chelating agent; antidote; Therapeutic: antidote
Pregnancy Category: C
100 mg/mL injection
Dithiol compound that combines with ions of various heavy metals to form relatively stable, nontoxic, soluble complexes
called chelates, which can be excreted; inhibition of enzymes by toxic metals is thus prevented.
Neutralizes the effects of various heavy metals.
Acute poisoning by arsenic, gold, and mercury; as adjunct to edetate calcium disodium (EDTA) in treatment of lead encephalopathy.
Chromium dermatitis; ocular and dermatologic manifestations of arsenic poisoning, as adjunct to penicillamine to increase
rate of copper excretion in Wilson's disease, and for poisoning with antimony, bismuth, chromium, copper, nickel, tungsten,
Hepatic insufficiency (with exception of post-arsenical jaundice); history of peanut oil hypersensitivity; severe renal
insufficiency; poisoning due to cadmium, iron, selenium, or uranium; pregnancy (category C), lactation.
Hypertension; oliguria; patients with G6PD deficiency; preexisting renal disease; rheumatoid arthritis.
Route & Dosage
|Arsenic or Gold Poisoning
Adult/Child: IM 2.53 mg/kg q4h for first 2 d, then q.i.d. on third day, then b.i.d. for 10 d
Adult/Child: IM 5 mg/kg initially, followed by 2.5 mg/kg 12 times/d for 10 d
Acute Lead Encephalopathy
Adult/Child: IM 4 mg/kg initially, then 34 mg/kg q4h with EDTA for 27 d depending on response
- Initiate therapy ASAP (within 12 h) after ingestion of the poison because irreversible tissue damage occurs quickly, particularly in mercury
- Give by deep IM injection only. Local pain, gluteal abscess, and skin sensitization possible. Rotate injection sites and
- Determine if a local anesthetic may be given with the injection to decrease injection site pain.
- Handle with caution; contact of drug with skin may produce erythema, edema, dermatitis.
- Note: Presence of sediment in ampule reportedly does not indicate drug deterioration.
Adverse Effects (≥1%)CNS:
Headache, anxiety, muscle pain or weakness, restlessness, paresthesias, tremors, convulsions,
shock. CV: Elevated BP,
tachycardia. Special Senses:
Rhinorrhea; burning sensation, feeling of pain and constriction in throat. GI:
burning sensation in lips and mouth, halitosis
, salivation; abdominal pain, metabolic acidosis. Urogenital:
Burning sensation in penis, renal damage. Other:
Pains in chest or hands, pain and sterile abscess at injection site, sweating, reduction in polymorphonuclear leukocytes
Diagnostic Test Interference
I131 thyroid uptake values may be decreased if test is done during or immediately following dimercaprol therapy.
Interactions Drug: Iron, cadmium, selenium, uranium
form toxic complexes with dimercaprol.
3060 min. Distribution:
Distributed mainly in intracellular spaces, including brain; highest concentrations in liver and kidneys. Elimination:
Completely excreted in urine and bile within 4 h. Half-Life:
Assessment & Drug Effects
- Monitor vital signs. Elevations of systolic and diastolic BPs accompanied by tachycardia frequently occur within a few minutes
following injection and may remain elevated up to 2 h.
- Note: Fever occurs in approximately 30% of children receiving treatment and may persist throughout therapy.
- Monitor I&O. Drug is potentially nephrotoxic. Report oliguria or change in I&O ratio to physician.
- Keep urine alkaline to reduce possibility of renal damage during elimination of dimercaprol chelate.
- Check urine daily for albumin, blood, casts, and pH. Blood and urinary levels of the metal serve as guides for dosage adjustments.
- Minor adverse reactions generally reach maximum 1520 min after drug administration and subside in 3090 min.
Ephedrine or an antihistamine is sometimes administered to prevent symptoms.
Patient & Family Education
- Drink as much fluid as the physician will permit.