Chelating Agents | Chelation Therapy and Oral Chelation

The most common Chelating Agents are:

Edetate disodium (disodium EDTA, edathamil disodium, sodium edetate): IV infusion for emergency treatment of acute hypercalcemia in selected patients.

Edetate calcium disodium (calcium disodium Versenate®, calcium EDTA, sodium calcium EDTA, edathamil calcium disodium, CaNa2-EDTA): can be used in conjunction with BAL in lead toxicity. IV infusion preferred, but may be used IM.

DMSA (dimercaptosuccinic acid, Succimer, Chemet®): an analogue of Dimercaprol that can be given orally for lead poisoning.

D-penicillamine (Cuprimine®, Depen®): an oral chelating agent used for copper poisoning or Wilson’s disease. May be used in lead poisoning but not as effective as DMSA.

Deferoxamine mesylate (desferrioxamine, Desferal®): used for acute or chronic iron toxicity due to transfusion dependent anemia or aluminum toxicity in patients with chronic renal failure undergoing dialysis. Intravenous (IV) preferred route of administration. Additionally, may be given subcutaneously (SQ) or intramuscularly (IM).

Deferasirox (ExJade®): an oral chelating agent used for the treatment of chronic iron overload due to blood transfusions (transfusional hemosiderosis) in patients 2 years of age and older.

Dimercaprol (BAL): lead toxicity in conjunction with calcium EDTA. Also used for arsenic, gold, and mercury toxicity. Administered intramuscularly (IM).

Different chelation agents are specific to certain kinds of poisonings. For example, edetate sodium (EDTA) treatment is specific for lead poisoning and extreme hypercalcemia. It has also been investigated for its effect on atherosclerosis due to suggestions of an antioxidant effect or the ability to remove calcium from arterial plaques.