Abstract
Background
The aim of the current study was to evaluate the efficacy of D-penicillamine in the treatment of lead poisoning mainly in the outpatient setting.
Methods
In a case series study performed during the recent epidemic of lead poisoning in Iran, lead-poisoned patients referring to our outpatient clinic were treated with 250-mg D-penicillamine capsules administered every 6 h for 5 or 10 days based on availability of the medication. They were recommended to re-check blood lead level (BLL) 4 weeks after cessation of the treatment and refer to our clinic again.
Results
In 63 patients with lead poisoning but without signs and symptoms of lead encephalopathy, median BLL was 106 [84, 131] μg/dL on presentation, which declined to a mean of 52.6 ± 28.8 μg/dL after a median treatment period of 7 [5, 10] days (p < 0.001). There was no statistically significant difference between the 5- and 10-day treatment protocols regarding complications and recovery. Treatment had resulted in a median decrease of 54 μg/dL [33, 90] (range: −20 to 231 μg/dL) in the patients’ BLLs (33.9% declined in BLL measurements; range: −29.69% to 99.06%).
Conclusions
D-penicillamine may be an acceptable substitute treatment in adult lead poisoning. Although our sample size was limited, we could not detect any serious adverse effects in our cases showing that D-penicillamine resulted in acceptable recovery rates. This may be helpful especially in epidemics with limitations in antidote access.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
References
[1] Chia BL, Leng CK, Hsii FP, Yap MH, Lee YK. Lead poisoning from contaminated opium. Br Med J 1973;1:354.10.1136/bmj.1.5849.354-aSearch in Google Scholar PubMed
[2] Jalili M, Azizkhani R. Lead toxicity resulting from chronic ingestion of opium. West J Emerg Med 2009;10:244–6.Search in Google Scholar PubMed
[3] Algora M, Martín-Castillo A, Zabala P, Fernández MN. [Lead poisoning due to drug addiction: a new source of poisoning with clinical interest and important epidemiological consequences]. An Med Interna 1989;6:483–5. Spanish.Search in Google Scholar PubMed
[4] Mokri A. Brief overview of the status of drug abuse in Iran. Arch Iran Med 2002;5:184–90.Search in Google Scholar
[5] Hassanian-Moghaddam H, Zamani N, Rahimi M, Shadnia S, Pajoumand A, Sarjami S. Acute adult and adolescent poisoning in Tehran, Iran; the epidemiologic trend between 2006 and 2011. Arch Iran Med 2014;17:534–8.Search in Google Scholar PubMed
[6] Hayatbakhsh Abbasi MM, Ansari M, Shahesmaeili A, Qaraie A. Lead serum levels in opium-dependent individuals. Addict Health 2009;1:106–9.Search in Google Scholar PubMed
[7] Masoodi M, Zali MR, Ehsani-Ardakani MJ, Mohammad-Alizadeh AH, Aiassofi K, Aghazadeh R, et al. Abdominal pain due to lead-contaminated opium: a new source of inorganic lead poisoning in Iran. Arch Iran Med 2006;9:72–5.Search in Google Scholar PubMed
[8] Aghaee-Afshar M, Khazaeli P, Behnam B, Rezazadehkermani M, Ashraf-Ganjooei N. Presence of lead in opium. Arch Iran Med 2008;11:553–4.Search in Google Scholar PubMed
[9] Soltaninejad K, Fluckiger A, Shadnia S. Opium addiction and lead poisoning. J Subst Abuse 2011;16:208–12.10.3109/14659891.2010.545860Search in Google Scholar
[10] Lifshitz M, Hashkanazi R, Phillip M. The effect of 2,3-dimercaptosuccinic acid in the treatment of lead poisoning in adults. Ann Med 1997;29:83–5.10.3109/07853899708998747Search in Google Scholar PubMed
[11] Nelson LS. Copper. In: Hoffman RS, Howland MA, Lewin NA, Nelson LS, Goldfrank LR, eds. Goldfrank’s Toxicologic Emergencies, 10th ed. New York: McGraw-Hills Press, 2015:1210–8.Search in Google Scholar
[12] Calello DP, Henretig FM. Lead. In: Hoffman RS, Howland MA, Lewin NA, Nelson LS, Goldfrank LR, eds. Goldfrank’s Toxicologic Emergencies, 10th ed. New York: McGraw-Hills Press, 2015:1219–34.Search in Google Scholar
[13] Shannon MW, Townsend MK. Adverse effects of reduced D-penicillamine in children with mild to moderate lead poisoning. Ann Pharmacother 2000;34:8–15.10.1345/aph.19084Search in Google Scholar
[14] Lowry JA. Oral chelation therapy for patients with lead poisoning. WHO factsheet. 2010. Cited 2015 Oct 25. http://www.who.int/selection_medicines/committees/expert/18/applications/4_2_LeadOralChelators.pdf.Search in Google Scholar
[15] Peterson RG, Rumack BH. D-penicillamine therapy of acute arsenic poisoning. J Pediatr 1977;91:661–6.10.1016/S0022-3476(77)80528-3Search in Google Scholar PubMed
[16] Sisombath NS, Jalilehvand F, Schell AC, Wu Q. Lead(II) binding to the chelating agent D-penicillamine in aqueous solution. Inorg Chem 2014;53:12459–68.10.1021/ic5018714Search in Google Scholar PubMed
[17] Shannon M, Graef J, Lovejoy FH Jr. Efficacy and toxicity of D-penicillamine in low level lead poisoning. J Pediatr 1988;112:799–804.10.1016/S0022-3476(88)83212-8Search in Google Scholar PubMed
© 2019 Walter de Gruyter GmbH, Berlin/Boston
