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Dimercaprol
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<h2 id="medical-uses">Medical uses</h2> <p>Dimercaprol has long been the mainstay of <a href="/facts/Chelation_therapy/BtIB1o8I">chelation therapy</a> for lead or arsenic poisoning,<a class="footnote-ref" id="fnref:11" href="#fn:11"><sup>11</sup></a> and it is an essential drug.<a class="footnote-ref" id="fnref:12" href="#fn:12"><sup>12</sup></a> It is also used as an antidote to the chemical weapon <a href="/facts/Lewisite/dXNbyngs">Lewisite</a>. Nonetheless, because it can have serious <a href="/facts/Adverse_effect/vAhfbr1J">adverse effects</a>, researchers have also pursued development of less toxic analogues,<a class="footnote-ref" id="fnref:13" href="#fn:13"><sup>13</sup></a> such as <a href="/facts/Succimer/6mmmuhVU">succimer</a>. </p><p><a href="/facts/Wilson%2527s_disease/Ktq8N2Uk">Wilson's disease</a> is a <a href="/facts/Genetic_disorder/hFqt2NLn">genetic disorder</a> in which <a href="/facts/Copper/I8PEE8oX">copper</a> builds up inside the <a href="/facts/Liver/Rtp4Fk2b">liver</a> and other tissues. Dimercaprol is a copper chelating agent that has been approved by the FDA to treat Wilson's disease.<a class="footnote-ref" id="fnref:14" href="#fn:14"><sup>14</sup></a> </p><p>Dimercaprol also shows effectiveness against <a href="/facts/Snakebite/jb4rUou8">snakebite</a> by potently antagonizing the activity of <a href="/facts/Zinc/80b1qgk3">Zn</a>2+-dependent <a href="/facts/Snake_venom/BBYrAvSh">snake venom</a> <a href="/facts/Metalloproteinase/ShDT6dbf">metalloproteinases</a> <i><a href="/facts/In_vitro/evp3hAX6">in vitro</a></i>.<a class="footnote-ref" id="fnref:15" href="#fn:15"><sup>15</sup></a> </p> <h2 id="mechanism-of-action">Mechanism of action</h2> <p><a href="/facts/Arsenic/k1c4f44D">Arsenic</a> and some other heavy metals act by chelating with adjacent <a href="/facts/Thiol/VemKEDP9">thiol</a> residues on metabolic enzymes, creating a <a href="/facts/Chelate/4G79sXBB">chelate</a> complex that inhibits the affected enzyme's activity.<a class="footnote-ref" id="fnref:16" href="#fn:16"><sup>16</sup></a> Dimercaprol competes with the thiol groups for binding the metal ion, which is then excreted in the urine. </p><p>Dimercaprol is itself toxic, with a narrow <a href="/facts/Therapeutic_index/h311pqE5">therapeutic range</a> and a tendency to concentrate arsenic in some organs. Other drawbacks include the need to administer it by painful <a href="/facts/Intramuscular_injection/PPNwW2wB">intramuscular injection</a><a class="footnote-ref" id="fnref:17" href="#fn:17"><sup>17</sup></a> Serious side effects include <a href="/facts/Nephrotoxicity/QaWn5pwB">nephrotoxicity</a> and <a href="/facts/Hypertension/wlAvBfcf">hypertension</a>. </p><p>Dimercaprol has been found to form stable chelates <i>in vivo</i> with many other metals including inorganic <a href="/facts/Mercury_(element)/WlxfoHva">mercury</a>, <a href="/facts/Antimony/YsA7lVgT">antimony</a>, <a href="/facts/Bismuth/75FLjkoX">bismuth</a>, <a href="/facts/Cadmium/wXkV2eIX">cadmium</a>, <a href="/facts/Chromium/6sVk6Uu7">chromium</a>, <a href="/facts/Cobalt/gqhScEw4">cobalt</a>, <a href="/facts/Gold/1znknojp">gold</a>, and <a href="/facts/Nickel/KwMCHYRP">nickel</a>. However, it is not necessarily the treatment of choice for toxicity to these metals. Dimercaprol has been used as an adjunct in the treatment of the acute encephalopathy of lead toxicity. It is a potentially toxic drug, and its use may be accompanied by multiple side effects. Although treatment with dimercaprol will increase the excretion of cadmium, there is a concomitant increase in renal cadmium concentration, so that its use in case of cadmium toxicity is to be avoided. It does, however, remove inorganic mercury from the kidneys; but is not useful in the treatment of alkylmercury or phenylmercury toxicity. Dimercaprol also enhances the toxicity of <a href="/facts/Selenium/k975NApC">selenium</a> and <a href="/facts/Tellurium/v7QvfIvS">tellurium</a>, so it is not to be used to remove these elements from the body. </p> <h2 id="history">History</h2> <p>The original name of dimercaprol reflects its origins as a <a href="/facts/Chemical_compound/37FXqqtv">compound</a> secretly developed by British biochemists at <a href="/facts/Oxford_University/ExVVQL6V">Oxford University</a> in the beginning of the <a href="/facts/World_War_II/2efV5L1U">World War II</a>, with the first synthesis in July 1940<a class="footnote-ref" id="fnref:18" href="#fn:18"><sup>18</sup></a><a class="footnote-ref" id="fnref:19" href="#fn:19"><sup>19</sup></a> as an <a href="/facts/Antidote/l9rHGlko">antidote</a> for <a href="/facts/Lewisite/dXNbyngs">lewisite</a>, a now-obsolete <a href="/facts/Arsenic/k1c4f44D">arsenic</a>-based <a href="/facts/Chemical_warfare_agent/AwXDDhAR">chemical warfare agent</a>.<a class="footnote-ref" id="fnref:20" href="#fn:20"><sup>20</sup></a> </p> <h2 id="see-also">See also</h2> <ul><li><a href="/facts/2%2c3-Dimercapto-1-propanesulfonic_acid/w4PTaaN5">2,3-Dimercapto-1-propanesulfonic acid</a></li> <li><a href="/facts/Dimercaptosuccinic_acid/6mmmuhVU">Dimercaptosuccinic acid</a></li> <li><a href="/facts/DMSA_scan/8fu6zV5B">DMSA scan</a></li> <li><a href="/facts/EDTA/XvHgKQyD">EDTA</a></li> <li><a href="/facts/Heavy_metal_poisoning/2VRBFJVm">Heavy metal poisoning</a></li> <li><a href="/facts/Penicillamine/1N0ErBRB">Penicillamine</a></li></ul> <h2 id="external-links">External links</h2> <ul><li><a href="https://druginfo.nlm.nih.gov/drugportal/name/dimercaprol">"Dimercaprol"</a>. <i>Drug Information Portal</i>. U.S. National Library of Medicine.</li></ul> <h2 id="references">References</h2> <ol> <li id="fn:1"><p>"Dimercaprol". The American Society of Health-System Pharmacists. Archived from the original on 21 December 2016. Retrieved 8 December 2016. <a href="https://www.drugs.com/monograph/dimercaprol.html" target="_blank">https://www.drugs.com/monograph/dimercaprol.html</a> <a href="#fnref:1" class="footnote-back-ref">↩</a></p></li> <li id="fn:2"><p>"Dimercaprol". The American Society of Health-System Pharmacists. Archived from the original on 21 December 2016. Retrieved 8 December 2016. <a href="https://www.drugs.com/monograph/dimercaprol.html" target="_blank">https://www.drugs.com/monograph/dimercaprol.html</a> <a href="#fnref:2" class="footnote-back-ref">↩</a></p></li> <li id="fn:3"><p>World Health Organization (2009). Stuart MC, Kouimtzi M, Hill SR (eds.). WHO Model Formulary 2008. World Health Organization. p. 62. hdl:10665/44053. 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