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<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE" /><meta name="citation_inbook_title" content="LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]" /><meta name="citation_title" content="Succimer" /><meta name="citation_publisher" content="National Institute of Diabetes and Digestive and Kidney Diseases" /><meta name="citation_date" content="2020/08/15" /><meta name="citation_pmid" content="31643429" /><meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK548099/" /><link rel="schema.DC" href="http://purl.org/DC/elements/1.0/" /><meta name="DC.Title" content="Succimer" /><meta name="DC.Type" content="Text" /><meta name="DC.Publisher" content="National Institute of Diabetes and Digestive and Kidney Diseases" /><meta name="DC.Date" content="2020/08/15" /><meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK548099/" /><meta name="description" content="Succimer is an oral heavy metal chelating agent used to treat lead and heavy metal poisoning. Succimer has been linked to a low rate of transient serum aminotransferase elevations during therapy, but its use has not been linked to cases of clinically apparent liver injury with jaundice." /><meta name="og:title" content="Succimer" /><meta name="og:type" content="book" /><meta name="og:description" content="Succimer is an oral heavy metal chelating agent used to treat lead and heavy metal poisoning. Succimer has been linked to a low rate of transient serum aminotransferase elevations during therapy, but its use has not been linked to cases of clinically apparent liver injury with jaundice." /><meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK548099/" /><meta name="og:site_name" content="NCBI Bookshelf" /><meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-livertox-lrg.png" /><meta name="twitter:card" content="summary" /><meta name="twitter:site" content="@ncbibooks" /><meta name="bk-non-canon-loc" content="/books/n/livertox/Succimer/" /><link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK548099/" /><link rel="stylesheet" href="/corehtml/pmc/css/figpopup.css" type="text/css" media="screen" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_print.min.css" type="text/css" media="print" /><style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} .body-content h2, .body-content .h2 {border-bottom: 1px solid #97B0C8} .body-content h2.inline {border-bottom: none} a.page-toc-label , .jig-ncbismoothscroll a {text-decoration:none;border:0 !important} .temp-labeled-list .graphic {display:inline-block !important} .temp-labeled-list img{width:100%}</style><script type="text/javascript" src="/corehtml/pmc/js/jquery.hoverIntent.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/common.min.js?_=3.18"> </script><script type="text/javascript" src="/corehtml/pmc/js/large-obj-scrollbars.min.js"> </script><script type="text/javascript">window.name="mainwindow";</script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/book-toc.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/books.min.js"> </script><meta name="book-collection" content="NONE" />
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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="All Drug Records" href="/books/n/livertox/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-livertox-lrg.png" alt="Cover of LiverTox" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK548099_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK548099_dtls__"><div>Bethesda (MD): <a href="https://www.niddk.nih.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Institute of Diabetes and Digestive and Kidney Diseases</a>; 2012-.</div></div><div class="half_rhythm"><ul class="inline_list"><li style="margin-right:1em"><a class="bk_cntns" href="/books/n/livertox/">Drug Records</a></li></ul></div><div class="bk_noprnt"><form method="get" action="/books/n/livertox/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div><div class="icnblk_cntnt two_col"><div class="pagination bk_noprnt"><a class="active page_link prev" href="/books/n/livertox/SubstanceAbuseTreatm/" title="Previous page in this title">< Prev</a><a class="active page_link next" href="/books/n/livertox/Sulfadiazine/" title="Next page in this title">Next ></a></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK548099_"><span class="title" itemprop="name">Succimer</span></h1><p class="small">Last Update: <span itemprop="dateModified">August 15, 2020</span>.</p></div><div class="body-content whole_rhythm" itemprop="text"><div id="Succimer.OVERVIEW"><h2 id="_Succimer_OVERVIEW_">OVERVIEW</h2><div id="Succimer.Introduction"><h3>Introduction</h3><p>Succimer is an oral heavy metal chelating agent used to treat lead and heavy metal poisoning. Succimer has been linked to a low rate of transient serum aminotransferase elevations during therapy, but its use has not been linked to cases of clinically apparent liver injury with jaundice.</p></div><div id="Succimer.Background"><h3>Background</h3><p>Succimer (sux’ i mer) or dimercaptosuccinic acid (DMSA) is an orally available heavy metal chelating agent that is used to treat lead poisoning in children. Succimer is an organo-sulfur compound with two sulfhydryl groups that bind divalent metal ions such as lead, cadmium, mercury, and arsenic. Succimer does not significantly chelate essential metals such as zinc, copper or iron, and its specificity, safety and oral availability make it preferable to other chelating agents for treating lead poisoning such as Ca-EDTA which must be given intravenously and dimercaprol (British anti-Lewisite [BAL]) which requires intramuscular administration. Succimer has been shown to lower blood lead levels and improve symptoms of chronic lead poisoning. Succimer was approved for use in the United States in 1991, and current indications are for treatment of lead poisoning in pediatric patients with plasma lead levels above 45 µg/dL. It is used off label to treat adults with lead poisoning and for therapy of arsenic and mercury intoxication. Succimer is also used in naturopathic medicine administered orally as well as intravenously as a part of chelation therapy for various conditions. Succimer is available in capsules of 100 mg generically and under the brand name Chemet. The recommended dose is 10 mg/kg (or 350 mg/m<sup>2</sup>) every 8 hours for 5 days, and reduce to every 12 hours for an additional 2 weeks of therapy, with a minimum 2 week rest period between repeated courses if lead levels remain high. Side effects are generally mild and may include headache, nausea, anorexia, diarrhea, rash, neutropenia and renal dysfunction. Uncommon, but potentially severe adverse events include hypersensitivity reactions. Intravenous administration of succimer as used in naturopathic medicine has not been approved for any indication and has been associated with sudden death attributed to hypocalcemia.</p></div><div id="Succimer.Hepatotoxicity"><h3>Hepatotoxicity</h3><p>In clinical trials conducted in children with lead poisoning, serum aminotransferase levels elevations occurred in 7% of succimer- vs 4% of placebo-treated subjects. However, <a class="def" href="/books/n/livertox/glossary/def-item/glossary.alanine-aminotransferase-alt-/">ALT</a> levels above 5 times the upper limit of normal were rare (<1% of treated patients) and no child had to stop therapy early because of liver test abnormalities. There have been no clinical reports of liver injury with jaundice attributed to succimer, but it has had limited general clinical use.</p><p><a class="def" href="/books/n/livertox/glossary/def-item/glossary.likelihood-score/">Likelihood score</a>: E (unlikely cause of clinically apparent liver injury).</p></div><div id="Succimer.Mechanism_of_Injury"><h3>Mechanism of Injury</h3><p>The mechanism of injury accounting for serum enzyme elevations during succimer therapy is not known. Succimer-metal chelates are eliminated in the urine.</p></div><div id="Succimer.Outcome_and_Management"><h3>Outcome and Management</h3><p>Serum aminotransferase elevations above 5 times the upper limit of normal (if confirmed) should lead to dose reduction or temporary cessation. Succimer has not been implicated in cases of acute liver failure, chronic hepatitis or vanishing bile duct syndrome. Despite the lack of evidence of significant liver injury from succimer, the product label recommends routine liver testing before and every week during therapy. There does not appear to be cross reactivity in risk for hepatic injury between succimer and other chelating agents including deferoxamine or deferiprone.</p><p>Drug Class: <a href="/books/n/livertox/ChelatingAgents/">Chelating Agents</a>, Lead Chelators</p></div></div><div id="Succimer.PRODUCT_INFORMATION"><h2 id="_Succimer_PRODUCT_INFORMATION_">PRODUCT INFORMATION</h2><p>
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<b>REPRESENTATIVE TRADE NAMES</b>
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</p><p>Succimer – Generic, Chemet®</p><p>
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<b>DRUG CLASS</b>
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</p><p>Chelating Agents</p><p>
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<a href="https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=Succimer" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">COMPLETE LABELING</a>
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</p><p>Product labeling at DailyMed, National Library of Medicine, NIH</p></div><div id="Succimer.CHEMICAL_FORMULA_AND_STRUCTURE"><h2 id="_Succimer_CHEMICAL_FORMULA_AND_STRUCTURE_">CHEMICAL FORMULA AND STRUCTURE</h2><div id="Succimer.Tc" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK548099/table/Succimer.Tc/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__Succimer.Tc_lrgtbl__"><table><thead><tr><th id="hd_h_Succimer.Tc_1_1_1_1" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">DRUG</th><th id="hd_h_Succimer.Tc_1_1_1_2" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CAS REGISTRY NO.</th><th id="hd_h_Succimer.Tc_1_1_1_3" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MOLECULAR FORMULA</th><th id="hd_h_Succimer.Tc_1_1_1_4" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">STRUCTURE</th></tr></thead><tbody><tr><td headers="hd_h_Succimer.Tc_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Succimer</td><td headers="hd_h_Succimer.Tc_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a href="https://pubchem.ncbi.nlm.nih.gov/substance/134973780" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem">304-55-2</a>
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</td><td headers="hd_h_Succimer.Tc_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">C4-H6-O4-S2</td><td headers="hd_h_Succimer.Tc_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a href="https://pubchem.ncbi.nlm.nih.gov/substance/134973780" title="View this structure in PubChem" class="img_link" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem"><img src="https://pubchem.ncbi.nlm.nih.gov/image/imgsrv.fcgi?t=l&sid=134973780" alt="image 134973780 in the ncbi pubchem database" /></a>
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</td></tr></tbody></table></div></div></div><div id="Succimer.ANNOTATED_BIBLIOGRAPHY"><h2 id="_Succimer_ANNOTATED_BIBLIOGRAPHY_">ANNOTATED BIBLIOGRAPHY</h2><p>References updated: 15 August 2020</p><ul class="first-line-outdent"><li><div class="bk_ref" id="Succimer.REF.zimmerman.1999">Zimmerman HJ. Hepatotoxicity: the adverse effects of drugs and other chemicals on the liver. 2nd ed. Philadelphia: Lippincott, 1999.<div><i>(Review of hepatotoxicity published in 1999; succimer is not discussed).</i></div></div></li><li><div class="bk_ref" id="Succimer.REF.kaplowitz.2013">Kaplowitz N, DeLeve LD, eds. Drug-induced liver disease. 3rd ed. Amsterdam: Elsevier, 2013.<div><i>(Textbook on hepatotoxicity; chelating agents are not discussed).</i></div></div></li><li><div class="bk_ref" id="Succimer.REF.byrns.2018">Byrns MC, Penning TM. Treatment of metal exposure. Environmental toxicology: carcinogens and heavy metals. In, Brunton LL, Hilal-Dandan R, Knollman BC, eds. Goodman & Gilman's the pharmacological basis of therapeutics. 13th ed. New York: McGraw-Hill, 2018, pp. 1311-15.<div><i>(Textbook of pharmacology and therapeutics).</i></div></div></li><li><div class="bk_ref" id="Succimer.REF.graziano.1992.133">Graziano
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JH, Lolacono
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NJ, Moulton
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T, Mitchell
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ME, Slavkovich
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V, Zarate
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C. Controlled study of meso-2,3-dimercaptosuccinic acid for the management of childhood lead intoxication.
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J Pediatr
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1992; 120: 133-9. [<a href="https://pubmed.ncbi.nlm.nih.gov/1309865" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1309865</span></a>]<div><i>(Among 19 children with high blood lead levels [50-69 µg/dL], succimer lowered levels by 61% which was more than achieved with intravenous Ca-EDTA [45%], and repeated courses of succimer prevented the rebound that typically occurs after a single course of therapy; one child had a transient minor increase in ALT levels [26 to 62 U/L]).</i></div></div></li><li><div class="bk_ref" id="Succimer.REF.glotzer.1993.85">Glotzer
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DE. The current role of 2,3-dimercaptosuccinic acid (DMSA) in the management of childhood lead poisoning.
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Drug Saf
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1993; 9: 85-92. [<a href="https://pubmed.ncbi.nlm.nih.gov/8397892" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8397892</span></a>]<div><i>(Review of the mechanism of action, efficacy and safety of succimer as a chelating agent for lead poisoning mentions that its safety profile is encouraging, but its use has been limited and its efficacy in preventing neurotoxicity from lead poisoning remains unproven).</i></div></div></li><li><div class="bk_ref" id="Succimer.REF.miller.1998.199">Miller
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AL. Dimercaptosuccinic acid (DMSA), a non-toxic, water-soluble treatment for heavy metal toxicity.
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Altern Med Rev
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1998; 3: 199-207. [<a href="https://pubmed.ncbi.nlm.nih.gov/9630737" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9630737</span></a>]<div><i>(Review of heavy metal poisoning from lead, mercury, arsenic and cadmium and the role of succimer therapy).</i></div></div></li><li><div class="bk_ref" id="Succimer.REF.guha_mazumder.1998.683">Guha Mazumder
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DN, Ghoshal
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UC, Saha
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J, Santra
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A, De
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BK, Chatterjee
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A, Dutta
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S, et al.
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Randomized placebo-controlled trial of 2,3-dimercaptosuccinic acid in therapy of chronic arsenicosis due to drinking arsenic-contaminated subsoil water.
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J Toxicol Clin Toxicol
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1998; 36: 683-90. [<a href="https://pubmed.ncbi.nlm.nih.gov/9865236" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9865236</span></a>]<div><i>(Among 21 patients with chronic arsenic toxicity due to drinking water contamination in West Bengal, there were no differences between succimer and placebo therapy in changes in symptoms or arsenic levels after 2 two-week courses).</i></div></div></li><li><div class="bk_ref" id="Succimer.REF8">Safety and efficacy of succimer in toddlers with blood lead levels of 20-44 microg/dL. Treatment of Lead-Exposed Children (TLC) Trial Group.
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Pediatr Res
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2000; 48: 593-9. [<a href="https://pubmed.ncbi.nlm.nih.gov/11044477" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11044477</span></a>]<div><i>(Among 780 children, ages 1-3 years, with moderately elevated blood lead levels [20-44 µg/dL] treated with up to 3 courses of succimer or placebo, there was no excess of any adverse event in either group, Alk P elevations occurred in 39% of both groups, ALT elevations greater than 2 times ULN occurred in 0.8% of succimer- and 1.1% in placebo-recipients, but were transient and confirmed on repeat testing in only 1 child).</i></div></div></li><li><div class="bk_ref" id="Succimer.REF.chisolm.2000.365">Chisolm
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JJ
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Jr. Safety and efficacy of meso-2,3-dimercaptosuccinic acid (DMSA) in children with elevated blood lead concentrations.
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J Toxicol Clin Toxicol
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2000; 38: 365-75. [<a href="https://pubmed.ncbi.nlm.nih.gov/10930052" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10930052</span></a>]<div><i>(Among 59 children given 116 four-week courses of succimer for lead toxicity, lead levels fell rapidly on treatment, but rebounded to 58% of pretreatment values thereafter; there were no adverse reactions).</i></div></div></li><li><div class="bk_ref" id="Succimer.REF.centers_for_disease_control_and_prevention_cdc_.2006.204">Centers for Disease Control and Prevention (CDC). Deaths associated with hypocalcemia from chelation therapy--Texas, Pennsylvania, and Oregon, 2003-2005.
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MMWR Morb Mortal Wkly Rep
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2006; 55: 204-7. [<a href="https://pubmed.ncbi.nlm.nih.gov/16511441" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16511441</span></a>]<div><i>(Description of 3 cases of sudden death from hypocalcemia caused by intravenous administration of Na2-EDTA as chelation for lead poisoning or as naturopathic chelation therapy to remove heavy metals; the patient with lead poisoning was also receiving oral succimer, and Na2-EDTA was mistakenly given instead of Ca-EDTA).</i></div></div></li><li><div class="bk_ref" id="Succimer.REF.adams.2009.16">Adams
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JB, Baral
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M, Geis
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E, Mitchell
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J, Ingram
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J, Hensley
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A, Zappia
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I, et al.
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Safety and efficacy of oral DMSA therapy for children with autism spectrum disorders: Part A--medical results.
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BMC Clin Pharmacol
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2009; 9: 16. [<a href="/pmc/articles/PMC2774660/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2774660</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/19852789" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19852789</span></a>]<div><i>(Among 65 children with autism spectrum disorder, ages 3 to 8 years, treated with up to 9 three-day cycles of succimer therapy, urinary excretion of lead, tin, copper, manganese and bismuth increased significantly, and there was no significant change in any blood chemistry result).</i></div></div></li><li><div class="bk_ref" id="Succimer.REF.kosnett.2013.347">Kosnett
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MJ. The role of chelation in the treatment of arsenic and mercury poisoning.
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J Med Toxicol
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2013; 9: 347-54. [<a href="/pmc/articles/PMC3846971/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3846971</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24178900" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24178900</span></a>]<div><i>(Review of the history, chemical structure, mechanism of action, preclinical and clinical assessment of the dithiol chelating agents, dimercaprol [BAL: British anti-Lewisite] and its two water soluble derivatives, dimercaptopropane sulfonic acid [DMPS, unithiol] and dimercaptosuccinic acid [DMSA: succimer] for their ability to chelate and lead to redistribution and secretion of arsenic, mercury and other heavy metals).</i></div></div></li><li><div class="bk_ref" id="Succimer.REF.bj_rnsson.2013.1419">Björnsson
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ES, Bergmann
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OM, Björnsson
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HK, Kvaran
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RB, Olafsson
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S. Incidence, presentation and outcomes in patients with drug-induced liver injury in the general population of Iceland.
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Gastroenterology
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2013; 144: 1419-25. [<a href="https://pubmed.ncbi.nlm.nih.gov/23419359" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23419359</span></a>]<div><i>(In a population based study of drug induced liver injury from Iceland, 96 cases were identified over a 2 year period, none of which were attributed to succimer).</i></div></div></li><li><div class="bk_ref" id="Succimer.REF.hern_ndez.2014.231">Hernández
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N, Bessone
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F, Sánchez
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A, di Pace
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M, Brahm
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J, Zapata
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R, A
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Chirino
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R, et al.
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Profile of idiosyncratic drug induced liver injury in Latin America. An analysis of published reports.
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Ann Hepatol
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2014; 13: 231-9. [<a href="https://pubmed.ncbi.nlm.nih.gov/24552865" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24552865</span></a>]<div><i>(Systematic review of literature of drug induced liver injury in Latin American countries published from 1996 to 2012 identified 176 cases, none of which were attributed to succimer or other chelating agents).</i></div></div></li><li><div class="bk_ref" id="Succimer.REF.chalasani.2015.1340">Chalasani
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N, Bonkovsky
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HL, Fontana
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R, Lee
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W, Stolz
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A, Talwalkar
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J, Reddy
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KR, et al.; United States Drug Induced Liver Injury Network. Features and outcomes of 899 patients with drug-induced liver injury: The DILIN Prospective Study.
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Gastroenterology
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2015; 148: 1340-1352.e7. [<a href="/pmc/articles/PMC4446235/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4446235</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25754159" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25754159</span></a>]<div><i>(Among 899 cases of drug induced liver injury enrolled in a US prospective study between 2004 and 2013, none were attributed to succimer or other chelating agents).</i></div></div></li><li><div class="bk_ref" id="Succimer.REF.breyre.2016.bcr2016215041">Breyre
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A, Green-McKenzie
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J. Case of acute lead toxicity associated with Ayurvedic supplements.
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BMJ Case Rep
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2016; 2016: bcr2016215041. [<a href="/pmc/articles/PMC4932351/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4932351</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27364782" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27364782</span></a>]<div><i>(26 year old man developed abdominal pain and anemia after having taken Ayurvedic medications for back pain for 4 months, blood lead levels 94.8 µg/dL treated with succimer in 4 courses which lowered levels rapidly to normal, bilirubin and ALT levels were “mildly” elevated initially but resolved with control of abdominal pain before starting succimer).</i></div></div></li><li><div class="bk_ref" id="Succimer.REF.grasso.2017.e1843">Grasso
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IA, Blattner
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MR, Short
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T, Downs
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JW. Severe systemic lead toxicity resulting from extra-articular retained shrapnel presenting as jaundice and hepatitis: a case report and review of the literature.
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Mil Med
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2017; 182: e1843-e1848. [<a href="https://pubmed.ncbi.nlm.nih.gov/28290970" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28290970</span></a>]<div><i>(31 year old active duty military policeman developed abdominal pain, peripheral neuropathy, anemia, weakness and jaundice, having sustained severe gunshot wounds 9 years earlier with residual shrapnel in his upper thigh, who was eventually found to have elevations in blood lead levels [125 µg/mL] and who eventually improved with chelation therapy, first BAL and EDTA followed by succimer; details of liver tests not provided).</i></div></div></li><li><div class="bk_ref" id="Succimer.REF.sakthithasan.2018.1143">Sakthithasan
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K, Lévy
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P, Poupon
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J, Garnier
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R.
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A comparative study of edetate calcium disodium and dimercaptosuccinic acid in the treatment of lead poisoning in adults.
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Clin Toxicol (Phila)
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2018; 56: 1143-1149. [<a href="https://pubmed.ncbi.nlm.nih.gov/29889577" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29889577</span></a>]<div><i>(Among 34 adults with high blood lead levels [>40 µg/dL] treated with either succimer or EDTA in 2 five-day courses, reduction in lead levels was greater with succimer but clinical symptoms improved with both treatments, while asymptomatic ALT elevations [<3 times ULN] arose in 25% vs 14% of patients, resolving in all when therapy was stopped).</i></div></div></li><li><div class="bk_ref" id="Succimer.REF.wilcox.2019.389">Wilcox
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MA, Hardin
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J, Weaver
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J, Voss
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EA. Liver test monitoring: real-world compliance for drugs with monitoring requirements at 2-week intervals or more frequently.
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Pharmaceut Med
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2019; 33: 389-94. [<a href="https://pubmed.ncbi.nlm.nih.gov/31933226" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31933226</span></a>]<div><i>(Analysis of 3 large health databases for compliance with recommendations for liver test monitoring when initiating therapy with 9 drugs found compliance in 139 patients treated with succimer to be only 29% for weekly monitoring as suggested by the product label; unclear whether succimer was being used for chelation of lead in children).</i></div></div></li></ul></div><div id="bk_toc_contnr"></div></div></div>
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<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK548099/?report=reader">PubReader</a></li><li><a href="/books/NBK548099/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK548099" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK548099" style="display:none" title="Cite this Page"><div class="bk_tt">LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Succimer. [Updated 2020 Aug 15].<span class="bk_cite_avail"></span></div></div></li><li><a href="/books/NBK548099/pdf/Bookshelf_NBK548099.pdf">PDF version of this page</a> (101K)</li><li><a href="#" class="toggle-glossary-link" title="Enable/disable links to the glossary">Disable Glossary Links</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>New and Updated</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="source-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22LiverTox%22+AND+pmcbook&sort=date&size=200" ref="pagearea=source-links&targetsite=external&targetcat=link&targettype=uri">In PubMed</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Bulk Download</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="source-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="https://ftp.ncbi.nlm.nih.gov/pub/litarch/29/31/" ref="pagearea=source-links&targetsite=external&targetcat=link&targettype=uri">Bulk download LiverTox data from FTP</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Overviews</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="source-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/n/livertox/intro/">Introduction</a></li><li><a href="/books/n/livertox/ClinicalCourse/">Clinical Course</a></li><li><a href="/books/n/livertox/ClinicalOutcome/">Clinical Outcomes</a></li><li><a href="/books/n/livertox/ImmuneFeatures/">Immune Features</a></li><li><a href="/books/n/livertox/Phenotypes_intro/">Phenotypes</a></li><li><a href="/books/n/livertox/Causality/">Causality</a></li><li><a href="/books/n/livertox/DrugCategory/">Likelihood Scale</a></li><li><a href="/books/n/livertox/Severity/">Severity Grading</a></li><li><a href="/books/n/livertox/CaseReport/">Writing a Case Report</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Support Links</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="source-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/n/livertox/">LiverTox Homepage</a></li><li><a href="/books/n/livertox/masterlistintro/">Master List of LiverTox Drugs [with Metadata]</a></li><li><a href="/books/n/livertox/drugliverinjury/">LiverTox Drugs by Drug Class</a></li><li><a href="/books/n/livertox/aboutus/">About LiverTox</a></li><li><a href="/books/n/livertox/editorsandreviewers/">Editors and Review Committee</a></li><li><a href="/books/n/livertox/alert/">Meetings and News</a></li><li><a href="/books/n/livertox/abbreviation/">Abbreviations Used</a></li><li><a href="/books/n/livertox/glossary/">Glossary</a></li><li><a href="/books/n/livertox/resource/">Information Resources</a></li><li><a href="/books/n/livertox/disclaimer/">User/Medical Advice Disclaimer</a></li><li><a href="/books/n/livertox/Contactus/">Contact Us</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>OTHER REFERENCE LINKS</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="document-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li>
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<a href="https://www.ncbi.nlm.nih.gov/sites/entrez?cmd=search&db=pubmed&pubmedfilters=true&term=Succimer+AND+Human%5BMH%5D+AND+(drug+induced+liver+injury+OR+jaundice/CI+OR+bile+duct+diseases/CI+OR+liver/DE+OR+liver+diseases/CI)+AND+(%221900/1/1%22%5BEDat%5D:%222999/12/31%22%5BEDat%5D)" ref="pagearea=document-links&targetsite=external&targetcat=link&targettype=uri">Recent References on Succimer: from PubMed.gov</a>
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<a href="https://clinicaltrials.gov/ct2/results?term=Succimer" ref="pagearea=document-links&targetsite=external&targetcat=link&targettype=uri">Trials on Succimer: from ClinicalTrials.gov</a>
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</li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related information</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="discovery_db_links" id="Shutter"></a></div><div class="portlet_content"><ul><li class="brieflinkpopper"><a class="brieflinkpopperctrl" href="/books/?Db=pmc&DbFrom=books&Cmd=Link&LinkName=books_pmc_refs&IdsFromResult=4864178" ref="log$=recordlinks">PMC</a><div class="brieflinkpop offscreen_noflow">PubMed Central citations</div></li><li class="brieflinkpopper"><a class="brieflinkpopperctrl" href="/books/?Db=pcsubstance&DbFrom=books&Cmd=Link&LinkName=books_pcsubstance&IdsFromResult=4864178" ref="log$=recordlinks">PubChem Substance</a><div class="brieflinkpop offscreen_noflow">Related PubChem Substances</div></li><li class="brieflinkpopper"><a class="brieflinkpopperctrl" href="/books/?Db=pubmed&DbFrom=books&Cmd=Link&LinkName=books_pubmed_refs&IdsFromResult=4864178" ref="log$=recordlinks">PubMed</a><div class="brieflinkpop offscreen_noflow">Links to PubMed</div></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Similar articles in PubMed</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PBooksDiscovery_RA" id="Shutter"></a></div><div class="portlet_content"><ul><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/8249780" ref="ordinalpos=1&linkpos=1&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Succimer: the first approved oral lead chelator.</a><span class="source">[Am Fam Physician. 1993]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Succimer: the first approved oral lead chelator.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Jorgensen FM. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">Am Fam Physician. 1993 Dec; 48(8):1496-502. </em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/37000134" ref="ordinalpos=1&linkpos=2&log$=relatedarticles&logdbfrom=pubmed">Dimercaptosuccinic Acid: Summary of Evidence.</a><span class="source">[Int J Pharm Compd. 2023]</span><div class="brieflinkpop offscreen_noflow">Dimercaptosuccinic Acid: Summary of Evidence.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Carvin J, Thompson T. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">Int J Pharm Compd. 2023 Mar-Apr; 27(2):94-96. </em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/1663439" ref="ordinalpos=1&linkpos=3&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Succimer, an oral lead chelator.</a><span class="source">[Clin Pharm. 1991]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Succimer, an oral lead chelator.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Mann KV, Travers JD. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">Clin Pharm. 1991 Dec; 10(12):914-22. </em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/31643745" ref="ordinalpos=1&linkpos=4&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Dimercaprol.</a><span class="source">[LiverTox: Clinical and Researc...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Dimercaprol.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. 2012</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/8575967" ref="ordinalpos=1&linkpos=5&log$=relatedarticles&logdbfrom=pubmed">Use of orally administered succimer (meso-2,3-dimercaptosuccinic acid) for treatment of lead poisoning in dogs.</a><span class="source">[J Am Vet Med Assoc. 1996]</span><div class="brieflinkpop offscreen_noflow">Use of orally administered succimer (meso-2,3-dimercaptosuccinic acid) for treatment of lead poisoning in dogs.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Ramsey DT, Casteel SW, Faggella AM, Chastain CB, Nunn JW, Schaeffer DJ. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">J Am Vet Med Assoc. 1996 Feb 1; 208(3):371-5. </em></div></div></li></ul><a class="seemore" href="/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed_reviews&uid=31643429" ref="ordinalpos=1&log$=relatedreviews_seeall&logdbfrom=pubmed">See reviews...</a><a class="seemore" href="/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed&uid=31643429" ref="ordinalpos=1&log$=relatedarticles_seeall&logdbfrom=pubmed">See all...</a></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Recent Activity</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="recent_activity" id="Shutter"></a></div><div class="portlet_content"><div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" id="HTDisplay" class=""><div class="action"><a href="javascript:historyDisplayState('ClearHT')">Clear</a><a href="javascript:historyDisplayState('HTOff')" class="HTOn">Turn Off</a><a href="javascript:historyDisplayState('HTOn')" class="HTOff">Turn On</a></div><ul id="activity"><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=1" href="/portal/utils/pageresolver.fcgi?recordid=67c8e1bcf4a390645e376bcb">Succimer - LiverTox</a><div class="ralinkpop offscreen_noflow">Succimer - LiverTox<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=2" href="/portal/utils/pageresolver.fcgi?recordid=67c8e1bbf4a390645e375f7e">Substance Abuse Treatment Agents - LiverTox</a><div class="ralinkpop offscreen_noflow">Substance Abuse Treatment Agents - LiverTox<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=3" href="/portal/utils/pageresolver.fcgi?recordid=67c8e1baa68b6b5afc79f6ad">Streptozocin - LiverTox</a><div class="ralinkpop offscreen_noflow">Streptozocin - LiverTox<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=4" href="/portal/utils/pageresolver.fcgi?recordid=67c8e1b9ab82281a80422ba9">Streptomycin - LiverTox</a><div class="ralinkpop offscreen_noflow">Streptomycin - LiverTox<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=5" href="/portal/utils/pageresolver.fcgi?recordid=67c8e1b9a68b6b5afc79eec7">Stiripentol - LiverTox</a><div class="ralinkpop offscreen_noflow">Stiripentol - LiverTox<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li></ul><p class="HTOn">Your browsing activity is empty.</p><p class="HTOff">Activity recording is turned off.</p><p id="turnOn" class="HTOff"><a href="javascript:historyDisplayState('HTOn')">Turn recording back on</a></p><a class="seemore" href="/sites/myncbi/recentactivity">See more...</a></div></div></div>
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