Succimer (Chemet)
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Succimer (Chemet)

CHEMET®
(succimer) Capsule 100 mg

DRUG DESCRIPTION

CHEMET (succimer) is an orally active, heavy metal chelating agent. The chemical name for succimer is meso 2, 3-dimercaptosuccinic acid (DMSA). Its empirical formula is C4H6O4S2 and molecular weight is 182.2. The meso-structural formula is:

Chemet (succimer) structural formula illustration

Succimer is a white crystalline powder with an unpleasant, characteristic mercaptan odor and taste.

Each CHEMET (succimer) opaque white capsule for oral administration, contains beads coated with 100 mg of succimer and is imprinted black with CHEMET (succimer) 100. Inactive ingredients in medicated beads are: povidone, sodium starch glycolate, starch and sucrose. Inactive ingredients in capsule are: gelatin, iron oxide, titanium dioxide and other ingredients.

What are the possible side effects of succimer (Chemet)?

Seek emergency medical attention or contact your doctor immediately if you experience any of the following rare but serious side effects to succimer:

  • an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives);
  • skin rash or sores in the mouth; or
  • signs of infection such as fever, sore throat, or coughing.

Other, less serious side effects may be more likely to occur. Continue to take succimer and talk to your doctor if you experience

  • nausea, vomiting, or decreased...

Read All Potential Side Effects and See Pictures of Chemet »

What are the precautions when taking succimer (Chemet)?

Before taking succimer, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease, liver disease.

During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.

It is unknown if this medication passes into breast milk. However, since this medication is used for lead poisoning and lead may pass into breast milk, do not breast-feed while using this...

Read All Potential Precautions of Chemet »

Last reviewed on RxList: 8/1/2007
This monograph has been modified to include the generic and brand name in many instances.

INDICATIONS

CHEMET (succimer) is indicated for the treatment of lead poisoning in pediatric patients with blood lead levels above 45 µg/dL. CHEMET (succimer) is not indicated for prophylaxis of lead poisoning in a lead-containing environment; the use of CHEMET (succimer) should always be accompanied by identification and removal of the source of the lead exposure.

DOSAGE AND ADMINISTRATION

Start dosage at 10 mg/kg or 350 mg/m2 every eight hours for five days. Initiation of therapy at higher doses is not recommended. (See Table II for Dosing chart and number of capsules.) Reduce frequency of administration to 10 mg/kg or 350 mg/m2 every 12 hours (two-thirds of initial daily dosage) for an additional two weeks of therapy. A course of treatment lasts 19 days. Repeated courses may be necessary if indicated by weekly monitoring of blood lead concentration. A minimum of two weeks between courses is recommended unless blood lead levels indicate the need for more prompt treatment.

TABLE II CHEMET (SUCCIMER) PEDIATRIC DOSING CHART

LBS KG DOSE (MG)* NUMBER OF
CAPSULES*
18-35 8-15 100 1
36-55 16-23 200 2
56-75 24-34 300 3
76-100 35-44 400 4
>100 > 45 500 5
*To be administered every 8 hours for 5 days, followed by dosing every 12 hours for 14 days.

In young pediatric patients who cannot swallow capsules, CHEMET (succimer) can be administered by separating the capsule and sprinkling the medicated beads on a small amount of soft food or putting them in a spoon and following with fruit drink.

Identification of the source of lead in the pediatric patient's environment and its abatement are critical to a successful therapy outcome. Chelation therapy is not a substitute for preventing further exposure to lead and should not be used to permit continued exposure to lead.

Patients who have received CaNa2EDTA with or without BAL may use CHEMET (succimer) for subsequent treatment after an interval of four weeks. Data on the concomitant use of CHEMET (succimer) with CaNa2EDTA with or without BAL are not available, and such use is not recommended.

HOW SUPPLIED

100 mg capsules in bottle of 100 (NDC 67386-201-11) Store between 15° C and 25° C and avoid excessive heat.

Rev. July 2007. Manufactured by: Schwarz Pharma Mfg., Inc. Seymour, IN 47274, USA
FDA Rev date: 7/11/2007

Last reviewed on RxList: 8/1/2007
This monograph has been modified to include the generic and brand name in many instances.

SIDE EFFECTS

Clinical experience with CHEMET (succimer) has been limited. Consequently, the full spectrum and incidence of adverse reactions including the possibility of hypersensitivity or idiosyncratic reactions have not been determined. The most common events attributable to succimer, i.e., gastrointestinal symptoms or increases in serum transaminases, have been observed in about 10% of patients (see PRECAUTIONS). Rashes, some necessitating discontinuation of therapy, have been reported in about 4% of patients. If rash occurs, other causes (e.g. measles) should be considered before ascribing the reaction to succimer. Rechallenge with succimer may be considered if lead levels are high enough to warrant retreatment. One allergic mucocutaneous reaction has been reported on repeated administration of the drug (see PRECAUTIONS). Mild to moderate neutropenia has been observed in some patients receiving succimer (see WARNINGS). Table I presents adverse events reported with the administration of succimer for the treatment of lead and other heavy metal intoxication.

TABLE I INCIDENCE OF ADVERSE EVENTS IN DOMESTIC STUDIES REGARDLESS OF ATTRIBUTION OR SUCCIMER DOSAGE

  Pediatric Patients (191) Adults (134)
% (n) % (n)
Digestive: 12.0 23 20.9 28
Nausea, vomiting, diarrhea, appetite loss, hemorrhoidal symptoms, loose stools, metallic taste in mouth.
Body as a Whole: 5.2 10 15.7 21
Back pain, abdominal cramps, stomach pains, head pain, rib pain, chills, flank pain, fever, flu-like symptoms, heavy head/tired, head cold, headache, moniliasis.
Metabolic: 4.2 8 10.4 14
Elevated SGPT, SGOT, alkaline phosphatase, elevated serum cholesterol.
Nervous: 1.0 2 12.7 17
Drowsiness, dizziness, sensorimotor neuropathy, sleepiness, paresthesia.
Skin and Appendages: 2.6 5 11.2 15
Papular rash, herpetic rash, rash, mucocutaneous eruptions, pruritus.
Special Senses: 1.0 2 3.7 5
Cloudy film in eye, ears plugged, otitis media, eyes watery.
Respiratory: 3.7 7 0.7 1
Throat sore, rhinorrhea, nasal congestion, cough.
Urogenital: 0.0 - 3.7 5
Decreased urination, voiding difficulty, proteinuria increased.
Cardiovascular: 0.0 - 1.8 2
Arrhythmia
Heme/Lymphatic: 0.5* 1 1.5* 2
Mild to moderate neutropenia, increased platelet count, intermittent eosinophilia.
Musculoskeletal: 0.0 - 3.0 4
Kneecap pain, leg pains.
*Does not include neutropenia - see WARNINGS

Read the Chemet (succimer) Side Effects Center for a complete guide to possible side effects »

DRUG INTERACTIONS

CHEMET (succimer) is not known to interact with other drugs including iron supplements; interactions have not been systematically studied. Concomitant administration of CHEMET (succimer) with other chelation therapy, such as CaNa2EDTA is not recommended.

Drug/Laboratory Tests Interaction: Succimer may interfere with serum and urinary laboratory tests. In vitro studies have shown succimer to cause false positive results for ketones in urine using nitroprusside reagents such as Ketostix® and falsely decreased measurements of serum uric acid and CPK.

Last reviewed on RxList: 8/1/2007
This monograph has been modified to include the generic and brand name in many instances.

WARNINGS

Keep out of reach of pediatric patients. CHEMET (succimer) is not a substitute for effective abatement of lead exposure.

Mild to moderate neutropenia has been observed in some patients receiving succimer. While a causal relationship to succimer has not been definitely established, neutropenia has been reported with other drugs in the same chemical class. A complete blood count with white blood cell differential and direct platelet counts should be obtained prior to and weekly during treatment with succimer. Therapy should either be withheld or discontinued if the absolute neutrophil count (ANC) is below 1200/µL and the patient followed closely to document recovery of the ANC to above 1500/µL or to the patient's baseline neutrophil count. There is limited experience with reexposure in patients who have developed neutropenia. Therefore, such patients should be rechallenged only if the benefit of succimer therapy clearly outweighs the potential risk of another episode of neutropenia and then only with careful patient monitoring.

Patients treated with succimer should be instructed to promptly report any signs of infection. If infection is suspected, the above laboratory tests should be conducted immediately.

PRECAUTIONS

The extent of clinical experience with CHEMET (succimer) is limited. Therefore, patients should be carefully observed during treatment.

General: Elevated blood lead levels and associated symptoms may return rapidly after discontinuation of CHEMET (succimer) because of redistribution of lead from bone stores to soft tissues and blood. After therapy, patients should be monitored for rebound of blood lead levels, by measuring blood lead levels at least once weekly until stable. However, the severity of lead intoxication (as measured by the initial blood lead level and the rate and degree of rebound of blood lead) should be used as a guide for more frequent blood lead monitoring.

All patients undergoing treatment should be adequately hydrated. Caution should be exercised in using CHEMET (succimer) therapy in patients with compromised renal function. Limited data suggests that CHEMET (succimer) is dialyzable, but that the lead chelates are not.

Transient mild elevations of serum transaminases have been observed in 6-10% of patients during the course of succimer therapy. Serum transaminases should be monitored before the start of therapy and at least weekly during therapy. Patients with a history of liver disease should be monitored closely. No data are available regarding the metabolism of succimer in patients with liver disease.

Clinical experience with repeated courses is limited. The safety of uninterrupted dosing longer than three weeks has not been established and it is not recommended.

The possibility of allergic or other mucocutaneous reactions to the drug must be borne in mind on readministration (as well as during initial courses). Patients requiring repeated courses of CHEMET (succimer) should be monitored during each treatment course. One patient experienced recurrent mucocutaneous vesicular eruptions of increasing severity affecting the oral mucosa, the external urethral meatus and the perianal area on the third, fourth and fifth courses of the drug. The reaction resolved between courses and upon discontinuation of therapy.

Carcinogenesis, Mutagenesis and Impairment of Fertility: CHEMET (succimer) has not been tested for carcinogenic potential in long-term animal studies. CHEMET (succimer) up to a dose of 510 mg/kg/day in males and 100 mg/kg/day in females did not show any adverse effect on fertility and reproductive performance. It was not mutagenic in the Ames bacterial assay and in the mammalian cell forward gene mutation assay.

Pregnancy: Teratogenic Effects - Pregnancy Category C. CHEMET (succimer) has been shown to be teratogenic and fetotoxic in pregnant mice when given subcutaneously in a dose range of 410 to 1640 mg/kg/day during the period of organogenesis. In a developmental study in rats, Chemet (succimer) produced maternal toxicity and deaths at the dose of 720 mg/kg/day or more during organogenesis.

The dose of 510 mg/kg/day was the highest tolerable dose in pregnant rats. Impaired development of reflexes was noted in pups of 720 mg/kg/day group dam. There are no adequate and well controlled studies in pregnant women. CHEMET (succimer) should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Nursing Mothers: It is not known whether this drug is excreted in human milk. Because many drugs and heavy metals are excreted in human milk, nursing mothers requiring CHEMET (succimer) therapy should be discouraged from nursing their infants.

Pediatric Use: Refer to the INDICATIONS and DOSAGE AND ADMINISTRATION sections. Safety and efficacy in pediatric patients less than 12 months of age have not been established.

Last reviewed on RxList: 8/1/2007
This monograph has been modified to include the generic and brand name in many instances.

OVERDOSE

Doses of 2300 mg/kg in the rat and 2400 mg/kg in the mouse produced ataxia, convulsions, labored respiration and frequently death. No case of overdosage has been reported in humans. Limited data indicate that succimer is dialyzable. In case of acute overdosage, induction of vomiting or gastric lavage followed by administration of an activated charcoal slurry and appropriate supportive therapy are recommended.

CONTRAINDICATIONS

CHEMET (succimer) should not be administered to patients with a history of allergy to the drug.

Last reviewed on RxList: 8/1/2007
This monograph has been modified to include the generic and brand name in many instances.

CLINICAL PHARMACOLOGY

Succimer is a lead chelator; it forms water soluble chelates and, consequently, increases the urinary excretion of lead.

Preclinical Toxicology: CHEMET (succimer) has low acute oral toxicity, with oral median lethal doses in rodents in excess of 3.6 g/kg. In a 28-day toxicity study, dogs receiving 30 and 100 mg/kg/day had lower urinary specific gravity and an increase in renal tubular regenerative hyperplasia. No renal toxicity was noted in dogs given 50 mg/kg/day orally for 14 consecutive days. In a chronic 6-month oral toxicity study, one male dog died (out of 7) at a dose of 200 mg/kg/day attributed to associated renal toxicity. Treatment related renal tubule epithelial changes in this study were observed in dogs after chronic (6-month) exposure to 110 and 200 mg/kg/day for 17 days then to 80 and 140 mg/kg/day for the remainder of the study. These changes were dose-dependent and correlated with increased kidney weights in male and female dogs at the 10 mg/kg/day dose. Nephropathy was not observed in dogs treated at 10 mg/kg/day. Reduced platelet counts were noted in 5 of 7 dogs receiving either 80 or 140 mg/kg/day for 3 or 6 months, although group means were not statistically different from concurrent controls. Platelets had not been quantified in earlier studies. Normal megakarycocytes in the bone marrow, plus the absence of fibrin degradation products or histologic evidence for DIC, suggested an autoimmune-mediated thrombocytopenia, a finding common in dogs but not in other species. However, serum antibody tests were inconclusive. Rats dosed chronically to 500 mg/kg/day developed no evidence for nephropathy or thrombocytopenia.

Pharmacokinetics: In a study performed in healthy adult volunteers, after a single dose of 14C-succimer at 16, 32, or 48 mg/kg, absorption was rapid but variable with peak blood radioactivity levels between one and two hours. On average, 49% of the radiolabeled dose was excreted: 39% in the feces, 9% in the urine and 1% as carbon dioxide from the lungs. Since fecal excretion probably represented nonabsorbed drug, most of the absorbed drug was excreted by the kidneys. The apparent elimination half-life of the radiolabeled material in the blood was about two days.

In other studies of healthy adult volunteers receiving a single oral dose of 10 mg/kg, the chemical analysis of succimer and its metabolites in the urine showed that succimer was rapidly and extensively metabolized. Approximately 25% of the administered dose was excreted in the urine with the peak blood level and urinary excretion occurring between two and four hours. Of the total amount of drug eliminated in the urine, approximately 90% was eliminated in altered form as mixed succimer-cysteine disulfides; the remaining 10% was eliminated unchanged. The majority of mixed disulfides consisted of succimer in disulfide linkages with two molecules of L-cysteine, the remaining disulfides contained one L-cysteine per succimer molecule.

Pharmacodynamics: Dose ranging studies were performed in 18 men with blood lead levels of 44-96 µg/dL. Three groups of 6 patients received either 10.0, 6.7 or 3.3 mg/kg succimer orally every 8 hours for 5 days. After five days the mean blood levels of the three groups decreased 72.5%. 58.3% and 35.5% respectively. The mean urinary lead excretions in the initial 24 hours were 28.6, 18.6 and 12.3 times the pretreatment 24 hour urinary lead excretion. As the chelatable pool was reduced during therapy, urinary lead output decreased. A mean of 19 mg of lead was excreted during a five-day course of 30 mg/kg/day succimer. Clinical symptoms, such as headache and colic, and biochemical indices of lead toxicity also improved. Decrease in urinary excretion of d-aminolevulinic acid (ALA) and coproporphyrin paralleled the improvement in erythrocyte d-aminolevulinic acid dehydratase (ALA-D). Three control patients with lead poisoning of similar severity received CaNa2EDTA intravenously at a dose of 50 mg/kg/day for five days. The mean blood lead level decreased 47.4% and the mean urinary lead excretion was 21 mg in the control patients.

Effect on Essential Minerals: In the above studies succimer had no significant effect on the urinary elimination of iron, calcium or magnesium. Zinc excretion doubled during treatment. The effect of succimer on the excretion of essential minerals was small compared to that of CaNa2EDTA, which can induce more than a ten-fold increase in urinary excretion of zinc and doubling of copper and iron excretion.

Efficacy: A dose ranging study was performed in 15 pediatric patients aged 2 to 7 years with blood lead levels of 30-49 µg/dL and positive CaNa2EDTA lead mobilization tests. Each group of five patients received 350, 233 or 116 mg/m2 succimer every 8 hours for 5 days. These doses corresponded to 10, 6.7 and 3.3 mg/kg. Six control patients received 1000 mg/m2/day CaNa2EDTA intravenously for 5 days. Following therapy, the mean blood lead levels decreased 78, 63 and 42% respectively in the three groups treated with succimer. The response of the 350 mg/m2 every 8 hours (10 mg/kg q 8 hr) group was significantly better than that of the other succimer treated groups as well as that of the control group, whose mean blood lead level fell 48%. No adverse reactions or changes in essential mineral excretion were reported in the succimer treated groups. In the CaNa2EDTA treated group, the cumulative amount of urinary lead excreted was slightly but significantly greater than in the succimer group. After CaNa2EDTA, the urinary excretion of copper, zinc, iron and calcium were significantly increased.

As with other chelators, both adults and pediatric patients experienced a rebound in blood lead levels after discontinuation of CHEMET (succimer) . In these studies, after treatment with a dose of 350 mg/m2 (10 mg/kg) every 8 hours for five days, the mean lead level rebounded and plateaued at 60-85% of pretreatment levels two weeks after therapy. The rebound plateau was somewhat higher with lower doses of succimer and with intravenous CaNa2EDTA.

In an attempt to control rebound of blood lead levels, 19 pediatric patients, ages 1-7 years, with blood lead levels of 42-67 µg/dL, were treated with 350 mg/m2 succimer every 8 hours for five days and then divided into three groups. One group was followed for two weeks with no further therapy, the second group was treated for two weeks with 350 mg/m2 daily, and the third with 350 mg/m2 every 12 hours. After the initial 5 days of therapy, the mean blood lead level in all subjects declined 61%. While the untreated group and the group treated with 350 mg/m2 daily experienced rebound during the ensuing two weeks, the group who received the 350 mg/m2 every 12 hours experienced no such rebound during the treatment period and less rebound following cessation of therapy.

In another study, ten pediatric patients, ages 21 to 72 months, with blood lead levels of 30-57 µg/dL were treated with succimer 350 mg/m2 every eight hours for five days followed by an additional 19-22 days of therapy at a dose of 350 mg/m2 every 12 hours. The mean blood lead levels decreased and remained stable at under 15 µg/dL during the extended dosing period.

In addition to the controlled studies, approximately 250 patients with lead poisoning have been treated with succimer either orally or parenterally in open U.S. and foreign studies with similar results reported. Succimer has been used for the treatment of lead poisoning in one patient with sickle cell anemia and in five patients with glucose-6-phosphodehydrogenase (G6PD) deficiency without adverse reactions.

Lead Encephalopathy: Three adults with lead encephalopathy have been reported in the literature to have improved with succimer therapy. However, data are not available regarding the use of succimer for the treatment of this rare and sometimes fatal complication of lead poisoning in pediatric patients.

Other Heavy Metal Poisoning: No controlled clinical studies have been conducted with succimer in poisoning with other heavy metals. A limited number of patients have received succimer for mercury or arsenic poisoning. These patients showed increased urinary excretion of the heavy metal and varying degrees of symptomatic improvement.

Last reviewed on RxList: 8/1/2007
This monograph has been modified to include the generic and brand name in many instances.

PATIENT INFORMATION

Patients should be instructed to maintain adequate fluid intake. If rash occurs, patients should consult their physician. Patients should be instructed to promptly report any indication of infection, which may be a sign of neutropenia (see WARNINGS and ADVERSE REACTIONS).

In young pediatric patients unable to swallow capsules, the contents of the capsule can be administered in a small amount of food (see DOSAGE AND ADMINISTRATION).

Last reviewed on RxList: 8/1/2007
This monograph has been modified to include the generic and brand name in many instances.

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PATIENT INFORMATION

Patients should be instructed to maintain adequate fluid intake. If rash occurs, patients should consult their physician. Patients should be instructed to promptly report any indication of infection, which may be a sign of neutropenia (see WARNINGS and ADVERSE REACTIONS).

In young pediatric patients unable to swallow capsules, the contents of the capsule can be administered in a small amount of food (see DOSAGE AND ADMINISTRATION).

Last reviewed on RxList: 8/1/2007
This monograph has been modified to include the generic and brand name in many instances.

Disclaimer

Chemet Consumer

IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

SUCCIMER - ORAL

(SUX-i-mer)

COMMON BRAND NAME(S): Chemet

USES: This medication is used to treat lead poisoning. It works by binding to the lead so that it may be removed by your kidneys. Removing lead from your body will lower the chance of severe problems caused by lead poisoning.

HOW TO USE: Take this medication by mouth with or without food, usually every 8 or 12 hours, or as directed by your doctor. Swallow the capsules whole. If you have trouble swallowing the capsule, you may open the capsule and sprinkle the contents on soft food (such as applesauce). Swallow all of the drug/food mixture immediately without chewing. You may also place the contents on a spoon and swallow with fruit juice.

Dosage and length of treatment is based on your medical condition, response to treatment, and body size.

Drink plenty of fluids while taking this medication unless your doctor directs you otherwise.

Use this medication regularly in order to get the most benefit from it. To help you remember, take it at the same times each day.

Disclaimer

Chemet Consumer (continued)

SIDE EFFECTS: Nausea, vomiting, loss of appetite, or diarrhea may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor immediately if any of these unlikely but serious side effects occur: signs of infection (such as fever, persistent sore throat).

A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US -

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Read the Chemet (succimer) Side Effects Center for a complete guide to possible side effects »

PRECAUTIONS: Before taking succimer, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease, liver disease.

During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.

It is unknown if this medication passes into breast milk. However, since this medication is used for lead poisoning and lead may pass into breast milk, do not breast-feed while using this drug.

Disclaimer

Chemet Consumer (continued)

DRUG INTERACTIONS: Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor or pharmacist first.

Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use.

This medication may interfere with certain laboratory tests (including uric acid levels, CPK levels, certain urine ketone tests), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.

Keep a list of all the products you use. Share the list with your doctor and pharmacist to reduce your risk for serious medication problems.

OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US National Poison Hotline at 1-800-222-1222. Canada residents can call a provincial poison control center.

NOTES: Do not share this medication with others.

It is important to remove the source of lead exposure. Consult your doctor or pharmacist for details on identifying and avoiding sources of lead exposure.

Laboratory and/or medical tests (such as complete blood count, blood lead levels, liver function tests) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

STORAGE: Store at room temperature between 59-77 degrees F (15-25 degrees C) away from light and moisture. Do not store in the bathroom. Keep all medicines away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

Information last revised September 2010. Copyright(c) 2010 First Databank, Inc.

Chemet Patient Information Including Side Effects

Brand Names: Chemet

Generic Name: succimer (Pronunciation: SUCK sih mer)

What is succimer (Chemet)?

Succimer is a chelating (binding) agent. Succimer binds to lead in the blood and allows it to be passed out in the urine.

Succimer is used in the treatment of lead poisoning.

Succimer may also be used for purposes other than those listed here.

What are the possible side effects of succimer (Chemet)?

Seek emergency medical attention or contact your doctor immediately if you experience any of the following rare but serious side effects to succimer:

  • an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives);
  • skin rash or sores in the mouth; or
  • signs of infection such as fever, sore throat, or coughing.

Other, less serious side effects may be more likely to occur. Continue to take succimer and talk to your doctor if you experience

  • nausea, vomiting, or decreased appetite;
  • diarrhea;
  • metallic taste in the mouth;
  • drowsiness;
  • dizziness;
  • watering eyes; or
  • headache.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome. You may report side effects to FDA at 1-800-FDA-1088.

Read the Chemet (succimer) Side Effects Center for a complete guide to possible side effects »

What is the most important information I should know about succimer (Chemet)?

Succimer can lower the activity of the immune system making you more susceptible to infection. Avoid contact with people who have colds, the flu, or other contagious illnesses. Contact your doctor immediately if you develop signs of infection such as fever, sore throat, or coughing.

Use caution when driving, operating machinery, or performing other hazardous activities. Succimer may cause drowsiness or dizziness. If you experience drowsiness or dizziness, avoid these activities.

Side Effects Centers

Chemet Patient Information including How Should I Take

What should I discuss with my healthcare provider before taking succimer (Chemet)?

Before taking succimer, talk to your doctor if you have

  • had a previous reaction to treatment with succimer;
  • blood problems;
  • kidney problems; or
  • liver problems.

You may not be able to take succimer, or you may require a dosage adjustment or special monitoring during treatment.

Succimer is in the FDA pregnancy category C. This means that it is not known whether it will be harmful to an unborn baby. Do not take succimer without first talking to your doctor if you are pregnant or could become pregnant during treatment.

It is not known whether succimer passes into breast milk and if it will affect a nursing baby. Do not take succimer without first talking to your doctor if you are breast-feeding a baby.

How should I take succimer (Chemet)?

Take succimer exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.

Take each dose with a full glass of water. Drink several extra glasses of water each day while taking succimer to maintain adequate hydration.

If swallowing the capsules is difficult, the capsules can be opened and the contents sprinkled onto a small amount of soft food. The mixture should be consumed entirely and immediately, not saved for later use. Alternatively, the contents of the capsule may be placed on a spoon, administered, and followed with a drink of fruit juice or other liquid.

It is important to take succimer regularly to get the most benefit.

Your doctor may want you to have blood tests or other medical evaluations during treatment with succimer to monitor progress and side effects.

Store sucralfate at room temperature away from moisture and heat.

Side Effects Centers

Chemet Patient Information including If I Miss a Dose

What happens if I miss a dose (Chemet)?

Take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and take only the next regularly scheduled dose. Do not take a double dose unless otherwise directed by your doctor.

What happens if I overdose (Chemet)?

Seek emergency medical attention if an overdose is suspected.

Symptoms of a succimer overdose may include poor coordination, weakness, seizures, difficulty breathing, and death.

What should I avoid while taking succimer (Chemet)?

Succimer can lower the activity of the immune system making you more susceptible to infection. Avoid contact with people who have colds, the flu, or other contagious illnesses. Contact your doctor immediately if you develop signs of infection such as fever, sore throat, or coughing.

Use caution when driving, operating machinery, or performing other hazardous activities. Succimer may cause drowsiness or dizziness. If you experience drowsiness or dizziness, avoid these activities.

What other drugs will affect succimer (Chemet)?

No other medications are known to interact with succimer. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including vitamins, minerals, and herbal products.

Where can I get more information?

Your pharmacist has additional information about succimer written for health professionals that you may read.


Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

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