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There are many ways you can help children and their families get the care they need.
Two common lead chelation medications are penicillamine and DMSA/ CHEMET.
Penicillamine is a drug that binds with lead in the body and increases its removal in the urine. Its brand name is Cuprimine. Penicillamine will get the lead out of the body, but it sometimes takes several months to do so.
Penicillamine is available as a capsule or tablet. The capsule can be opened and sprinkled on food, or mixed into a small amount of liquid. The tablet may be crushed with a spoon. Capsules are available in 125 mg. or 250 mg. strength. Tablets are 250 mg., but are scored so they can be broken in half or quartered.
It may be given with fruit juices, applesauce, chocolate syrup, Zarex (fruit juice concentrate), jelly or non-dairy whipped cream. It should be given on an empty stomach (1/2 hour before or 2 hours after meals). A few children however, may complain of an upset stomach when it is given with food and they may need some crackers or a small snack.
It is very important that your child receives all of the doses of penicillamine that the doctor has ordered. Because of the potential adverse effects of penicillamine, it is also important that your child returns to the lead clinic for all of his/ her scheduled visits. When you child begins penicillamine, it is essential for us to see him/her in the Lead Clinic two weeks after starting treatment. After two weeks on the medication, if all is going well, we can space the visits out to once a month.
Your child may need to take penicillamine for as long as three to four months.
Iron treatment should not be given at the same time as penicillamine, and penicillamine should not be given with milk or milk products. You can give penicillamine 2 hours before or 2 hours after any iron or calcium product.
Your doctor will have discussed the possible but unlikely side effects of penicillamine with you. Pharmacy information and medication labelling give side effects for penicillamine when it is used in adults for other ilnesses. The risk of side effects when penicillamine is given to children is extremely low and completely different than the risks for the adult.
These side effects include allergy to the drug (5-7% risk), which may cause a skin rash, a decrease in the number of white blood cells and/ or platelets (risk is <1%). The rash of penicillamine consists of red, raised bumps on the face and/ or trunk. These side effects will go away when the medication is stopped.
A strong medication odor appears in the urine when children are taking penicillamine; this is to be expected and it is not a problem. Since we are looking for any changes in your child's blood and urine, we will ask for a blood test and urine sample at each visit.
DMSA, also known as Chemet and Succimer, is a drug that binds with the lead in the body and increases its removal in the urine.
DMSA comes in capsules only. The capsule can be opened and sprinkled on food if your child is unable to swallow pills.
The medicine has a bad smell and taste. It will be better tolerated by your child if it is mixed with something sweet tasing such as chocolate syrup, ice cream, pudding or jellies. The capsule can be mixed with food 5-10 minutes before administering so that some of the smell will evaporate.
DMSA is dosed according to your child's weight, and is given over a specified course of time by your doctor. It is very important that your child receives all of the doses of DMSA that the doctor has ordered or the medicine will not work as it should. It is also important that your child returns to the Lead Clinic for all his/her scheduled visits, so that we can monitor him/her for any possible side effects. Your child may need a second or even third course of DMSA in a few weeks.
DMSA may cause some temporary elevations in your child's liver enzymes. We will draw blood work at each clinic visit both to monitor his/her lead levels and to look for any possible adverse effects. DMSA may also cause a skin rash, however, this is rare.
If your child develops a rash while taking DMSA or if you have other questions or concerns please call the Lead Clinic on Monday, Wednesday or Friday to speak with the nurse. You can also page your Lead Clinic doctor or the toxicology fellow on call.
Either person can be reached by calling the Page operator at (617) 355-6369. Nora Llach, R.N., M.P.H. Boston Children's Hospital
We are grateful to have been ranked #1 on U.S. News & World Report's list of the best children's hospitals in the nation for the third year in a row, an honor we could not have achieved without the patients and families who inspire us to do our very best for them. Thanks to you, Boston Children's is a place where we can write the greatest children's stories ever told.”