二巯丁二酸胶囊有什么不良反应？
时间： 18:18:08
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最近表弟不知道吃什么东西，浑身总感觉到恶心，去医院检查是重金属中毒，我们打完吊瓶以后，大夫又给我们开了几盒二巯丁二酸胶囊，表弟属于过敏体质不知道用这个药有没有问题。
想得到怎样的帮助：二巯丁二酸胶囊有什么不良反应？（感谢医生为我快速解答——该。）
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你好，服用二巯丁二酸胶囊常见不良反应有恶心、呕吐、腹泻、食欲丧失、稀便等胃肠道反应。偶见皮疹，本药严谨严重肝功能障碍和妊娠妇女服用。
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恶心(nausea)是一种可以引起呕吐冲动的胃内不适感,常为呕吐的前驱感觉，但也可单独出现，主要表现为上腹部的特殊不适感，常伴有头晕、流涎、脉搏缓慢、血压降低等迷走神经兴奋症状。......
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&&&&&尚正明远研究院为您提供2013年中国二巯丁二酸胶囊行业投资分析及前景预测报告。2013年中国二巯丁二酸胶囊行业投资分析及前景预测报告&&&&
-------------------------------------------&&&&
【报告编号】：75603&&&&
【关 键 字】：二巯丁二酸胶囊&&&&
【报告价格】: 【纸质版】: 6500元 【电子版】: 6800元 【合订本】: 7000元(来电有优惠)&&&&
【电话订购】: 010-0- &&&&
【绿色通道】:
【QQ 咨 询】: &&&&
【联 系 人】: 李晓&&&&
【网站链接】：/qitaxingye/qita/75603.html（点击进入网站查阅正文)&&&&
【报告目录】&&&&
第一章 二巯丁二酸胶囊概述 14&&&&
第一节 二巯丁二酸胶囊定义 14&&&&
第二节 二巯丁二酸胶囊行业发展历程 14&&&&
第三节 二巯丁二酸胶囊分类情况 14&&&&
第四节 二巯丁二酸胶囊产业链分析 15&&&&
一、产业链介绍 15&&&&
二、二巯丁二酸胶囊产业链模型分析 18&&&&
第二章 年中国二巯丁二酸胶囊行业发展环境分析 19&&&&
一、宏观经济 19&&&&
二、工业形势 21&&&&
三、固定资产投资 21&&&&
第二节 年中国二巯丁二酸胶囊行业发展政策环境分析 23&&&&
一、行业政策影响分析 23&&&&
二、相关行业标准分析 23&&&&
第三节 年中国二巯丁二酸胶囊行业发展社会环境分析 24&&&&
一、居民消费水平分析 24&&&&
二、工业发展形势分析 25&&&&
第三章 中国二巯丁二酸胶囊生产现状分析 26&&&&
第一节 二巯丁二酸胶囊行业总体规模 26&&&&
第二节 二巯丁二酸胶囊产能概况 27&&&&
一、年产能分析 27&&&&
二、年产能预测 29&&&&
第三节 二巯丁二酸胶囊产量概况 29&&&&
一、年产量分析 29&&&&
二、产能配置与产能利用率调查 30&&&&
三、年产量预测 32&&&&
第四节 二巯丁二酸胶囊产业的生命周期分析 32&&&&
第五节二巯丁二酸胶囊产业供需情况 35&&&&
北京产业信息研究院--网址:/&&&&
第四章 二巯丁二酸胶囊国内产品价格走势及影响因素分析 35&&&&
第一节 国内产品年价格回顾 35&&&&
第二节 国内产品当前市场价格及评述 36&&&&
第三节 国内产品价格影响因素分析 36&&&&
第四节 年国内产品未来价格走势预测 38&&&&
第五章 2010年我国二巯丁二酸胶囊行业发展现状分析 39&&&&
第一节 我国二巯丁二酸胶囊行业发展现状 39&&&&
一、二巯丁二酸胶囊行业品牌发展现状 39&&&&
二、二巯丁二酸胶囊行业需求市场现状 39&&&&
三、二巯丁二酸胶囊市场需求层次分析 40&&&&
四、我国二巯丁二酸胶囊市场走向分析 41&&&&
第二节 中国二巯丁二酸胶囊产品技术分析 41&&&&
一、2012年二巯丁二酸胶囊产品技术变化特点 41&&&&
二、2012年二巯丁二酸胶囊产品市场的新技术 41&&&&
三、2012年二巯丁二酸胶囊产品市场现状分析 42&&&&
第三节 中国二巯丁二酸胶囊行业存在的问题 43&&&&
一、二巯丁二酸胶囊产品市场存在的主要问题 43&&&&
二、国内二巯丁二酸胶囊产品市场的三大瓶颈 43&&&&
三、二巯丁二酸胶囊产品市场遭遇的规模难题 43&&&&
第四节 对中国二巯丁二酸胶囊市场的分析及思考 44&&&&
一、二巯丁二酸胶囊市场特点 44&&&&
二、二巯丁二酸胶囊市场分析 44&&&&
三、二巯丁二酸胶囊市场变化的方向 44&&&&
四、中国二巯丁二酸胶囊行业发展的新思路 44&&&&
五、对中国二巯丁二酸胶囊行业发展的思考 45&&&&
第六章 2009年中国二巯丁二酸胶囊行业发展概况 46&&&&
第一节 2012年中国二巯丁二酸胶囊行业发展态势分析 46&&&&
第二节 2012年中国二巯丁二酸胶囊行业发展特点分析 47&&&&
第三节 2012年中国二巯丁二酸胶囊行业市场供需分析 47&&&&
第七章 二巯丁二酸胶囊行业市场竞争策略分析 48&&&&
第一节行业竞争结构分析 48&&&&
一、现有企业间竞争 49&&&&
二、潜在进入者分析 49&&&&
三、替代品威胁分析 49&&&&
四、供应商议价能力 50&&&&
五、客户议价能力 50&&&&
第二节二巯丁二酸胶囊市场竞争策略分析 50&&&&
一、二巯丁二酸胶囊市场增长潜力分析 50&&&&
二、二巯丁二酸胶囊产品竞争策略分析 51&&&&
三、典型企业产品竞争策略分析 51&&&&
第三节二巯丁二酸胶囊企业竞争策略分析 53&&&&
一、年我国二巯丁二酸胶囊市场竞争趋势 53&&&&
二、年二巯丁二酸胶囊行业竞争格局展望 54&&&&
三、年二巯丁二酸胶囊行业竞争策略分析 55&&&&
第八章 二巯丁二酸胶囊行业投资与发展前景分析 59&&&&
第一节2012年二巯丁二酸胶囊行业投资情况分析 59&&&&
一、2012年总体投资结构 59&&&&
二、2012年投资规模情况 60&&&&
三、2012年投资增速情况 60&&&&
四、2012年分地区投资分析 61&&&&
第二节二巯丁二酸胶囊行业投资机会分析 62&&&&
一、二巯丁二酸胶囊投资项目分析 62&&&&
二、可以投资的二巯丁二酸胶囊模式 63&&&&
三、2012年二巯丁二酸胶囊投资机会 64&&&&
四、2012年二巯丁二酸胶囊投资新方向 65&&&&
第三节二巯丁二酸胶囊行业发展前景分析 65&&&&
一、金融危机下二巯丁二酸胶囊市场的发展前景 65&&&&
二、2012年二巯丁二酸胶囊市场面临的发展商机 66&&&&
第九章 年中国二巯丁二酸胶囊行业发展前景预测分析 67&&&&
第一节年中国二巯丁二酸胶囊行业发展预测分析 67&&&&
一、未来二巯丁二酸胶囊发展分析 67&&&&
二、未来二巯丁二酸胶囊行业技术开发方向 68&&&&
三、总体行业“十二五”整体规划及预测 68&&&&
第二节年中国二巯丁二酸胶囊行业市场前景分析 70&&&&
一、产品差异化是企业发展的方向 70&&&&
二、渠道重心下沉 72&&&&
北京产业信息研究院--客服人员--李晓&&&&
第十章 二巯丁二酸胶囊上游原材料供应状况分析 73&&&&
第一节 主要原材料 73&&&&
第二节 主要原材料年价格及供应情况 76&&&&
第三节 年主要原材料未来价格及供应情况预测 76&&&&
第十一章 二巯丁二酸胶囊行业上下游分析 77&&&&
第一节 行业上游分析 77&&&&
一、发展现状 77&&&&
二、发展趋势预测 77&&&&
三、行业新动态及其对二巯丁二酸胶囊行业的影响 78&&&&
四、行业竞争状况及其对二巯丁二酸胶囊行业的意义 78&&&&
第二节 行业下游分析 78&&&&
一、发展现状 78&&&&
二、发展趋势预测 79&&&&
三、市场现状分析 79&&&&
四、行业新动态及其对二巯丁二酸胶囊行业的影响 79&&&&
五、行业竞争状况及其对二巯丁二酸胶囊行业的意义 80&&&&
第十二章 年二巯丁二酸胶囊行业发展趋势及投资风险分析 80&&&&
第一节 当前二巯丁二酸胶囊存在的问题 80&&&&
第二节 二巯丁二酸胶囊未来发展预测分析 80&&&&
一、中国二巯丁二酸胶囊发展方向分析 80&&&&
二、年中国二巯丁二酸胶囊行业发展规模 81&&&&
三、年中国二巯丁二酸胶囊行业发展趋势预测 81&&&&
第三节 年中国二巯丁二酸胶囊行业投资风险分析 82&&&&
一、市场竞争风险 82&&&&
二、原材料压力风险分析 83&&&&
三、技术风险分析 83&&&&
四、政策和体制风险 83&&&&
五、外资进入现状及对未来市场的威胁 84&&&&
第十三章 二巯丁二酸胶囊国内重点生产厂家分析 84&&&&
订购热线：010-
值班热线：&&&&
第一节 **A公司 84（企业可选）&&&&
一、企业基本概况84&&&&
二、年企业经营与财务状况分析 86&&&&
三、年企业竞争优势分析 87&&&&
四、企业未来发展战略与规划 89&&&&
第二节 **B公司 91&&&&
一、企业基本概况 91&&&&
二、年企业经营与财务状况分析 93&&&&
三、年企业竞争优势分析 95&&&&
四、企业未来发展战略与规划 96&&&&
第三节 **C公司 97&&&&
一、企业基本概况 97&&&&
二、年企业经营与财务状况分析 98&&&&
三、年企业竞争优势分析 100&&&&
四、企业未来发展战略与规划 103&&&&
第四节 **D公司 104&&&&
一、企业基本概况 104&&&&
二、年企业经营与财务状况分析 106&&&&
三、年企业竞争优势分析 107&&&&
四、企业未来发展战略与规划 109&&&&
第五节 **E公司 111&&&&
一、企业基本概况 111&&&&
二、年企业经营与财务状况分析 112&&&&
三、年企业竞争优势分析 114&&&&
四、企业未来发展战略与规划 117&&&&
第十四章 二巯丁二酸胶囊地区销售分析 118&&&&
第一节中国二巯丁二酸胶囊区域销售市场结构变化 118&&&&
第二节 二巯丁二酸胶囊“东北地区”销售分析 119&&&&
一、年东北地区销售规模 119&&&&
二、东北地区“规格”销售分析 120&&&&
三、年东北地区“规格”销售规模分析 120&&&&
第三节 二巯丁二酸胶囊“华北地区”销售分析 121&&&&
一、年华北地区销售规模 121&&&&
二、华北地区“规格”销售分析 121&&&&
三、年华北地区“规格”销售规模分析 122&&&&
第四节 二巯丁二酸胶囊“中南地区”销售分析 122&&&&
一、年中南地区销售规模 122&&&&
二、中南地区“规格”销售分析 123&&&&
三、年中南地区“规格”销售规模分析 123&&&&
第五节 二巯丁二酸胶囊“华东地区”销售分析 124&&&&
一、年华东地区销售规模 124&&&&
二、华东地区“规格”销售分析 124&&&&
三、年华东地区“规格”销售规模分析 125&&&&
第六节 二巯丁二酸胶囊“西北地区”销售分析 126&&&&
一、年西北地区销售规模 126&&&&
二、西北地区“规格”销售分析 126&&&&
第十五章年中国二巯丁二酸胶囊行业投资战略研究 127&&&&
第一节年中国二巯丁二酸胶囊行业投资策略分析 127&&&&
一、二巯丁二酸胶囊投资策略 127&&&&
二、二巯丁二酸胶囊投资筹划策略 127&&&&
三、2012年二巯丁二酸胶囊品牌竞争战略 128&&&&
第二节年中国二巯丁二酸胶囊行业品牌建设策略 130&&&&
一、二巯丁二酸胶囊的规划 130&&&&
二、二巯丁二酸胶囊的建设 131&&&&
三、二巯丁二酸胶囊业成功之道 131&&&&
第十六章 北京产业信息研究院市场指标预测及行业项目投资建议 131&&&&
第一节 中国二巯丁二酸胶囊行业市场发展趋势预测 131&&&&
第二节 二巯丁二酸胶囊产品投资机会 132&&&&
第三节 二巯丁二酸胶囊产品投资趋势分析 132&&&&
第四节 项目投资建议 133&&&&
一、行业投资环境考察 133&&&&
二、投资风险及控制策略 137&&&&
三、产品投资方向建议 137&&&&
四、项目投资建议 137&&&&
1、技术应用注意事项 137&&&&
2、项目投资注意事项 138&&&&
3、生产开发注意事项 140&&&&
4、销售注意事项 142&&&&
【图表目录】&&&&
图表、产业链形成模式示意图 16&&&&
图表、二巯丁二酸胶囊产业链结构图 17&&&&
图表、年我国季度GDP增长率 单位：% 19&&&&
图表、年我国三产业增加值季度增长率 单位：% 19&&&&
图表、年我国工业增加值走势图 单位：% 20&&&&
图表、年固定资产投资走势图 单位：% 22&&&&
图表、年我国CPI、PPI运行趋势 单位：% 24&&&&
图表、年我国二巯丁二酸胶囊市场规模统计表 26&&&&
图表、年我国二巯丁二酸胶囊市场规模及增长率变化图 27&&&&
图表、年我国二巯丁二酸胶囊产能统计表 27&&&&
图表、年我国二巯丁二酸胶囊产能及增长率变化图 28&&&&
图表、年中国二巯丁二酸胶囊产能及增长率预测 28&&&&
图表、年我国二巯丁二酸胶囊产量统计表 29&&&&
图表、年我国二巯丁二酸胶囊产量及增长率变化图 30&&&&
图表、年中国二巯丁二酸胶囊产能利用率变化 31&&&&
图表、年中国二巯丁二酸胶囊产能利用率变化 31&&&&
图表、年中国二巯丁二酸胶囊产量及增长率预测 32&&&&
图表、行业生命周期、战略及其特征 33&&&&
图表、年中国二巯丁二酸胶囊行业市场供需分析 34&&&&
图表、年国内二巯丁二酸胶囊平均价格走势 35&&&&
图表、2012年我国二巯丁二酸胶囊市场不同因素的价格影响力对比 37&&&&
图表、年中国二巯丁二酸胶囊平均价格走势预测 38&&&&
图表、年中国二巯丁二酸胶囊行业需求市场分析 39&&&&
图表、我国二巯丁二酸胶囊市场需求结构图 40&&&&
图表、年我国二巯丁二酸胶囊市场规模及增长率变化图 42&&&&
图表、年我国二巯丁二酸胶囊产能及增长率变化图 46&&&&
图表、年我国二巯丁二酸胶囊产量及增长率变化图 47&&&&
图表、年中国二巯丁二酸胶囊行业市场供需分析 47&&&&
图表、二巯丁二酸胶囊行业环境“波特五力”分析模型 48&&&&
图表、年我国二巯丁二酸胶囊市场规模及增长率变化图 50&&&&
图表、年二巯丁二酸胶囊十强企业市场占有率预测 54&&&&
图表、二巯丁二酸胶囊生产企业定价目标选择 57&&&&
图表、二巯丁二酸胶囊企业对付竞争者降价的程序 58&&&&
图表、2012年二巯丁二酸胶囊总体投资结构分析 59&&&&
图表、年投资规模情况分析 60&&&&
图表、年投资额增速分析 60&&&&
图表、2012年投资地区情况分析 61&&&&
图表、二巯丁二酸胶囊项目投资注意事项图 63&&&&
图表、年中国二巯丁二酸胶囊投资机会分析 64&&&&
图表、年二巯丁二酸胶囊行业投资方向预测 65&&&&
图表、影响市场供需的因素分析 66&&&&
图表、年中国二巯丁二酸胶囊市场发展商机分析 66&&&&
图表、年中国二巯丁二酸胶囊市场发展商机分析 67&&&&
图表、年我国二巯丁二酸胶囊原材料价格分析 76&&&&
图表、年我国二巯丁二酸胶囊原材料价格预测 76&&&&
图表、年中国二巯丁二酸胶囊行业发展规模预测 81&&&&
图表、年中国二巯丁二酸胶囊行业发展趋势预测 81&&&&
图表、年二巯丁二酸胶囊组行业同业竞争风险及控制策略 82&&&&
图表、近4年**A公司流动资产周转次数变化情况 85&&&&
图表、近3年**A公司流动资产周转次数变化情况 85&&&&
图表、近4年**A公司总资产周转次数变化情况 86&&&&
图表、近3年**A公司总资产周转次数变化情况 86&&&&
图表、近4年**A公司销售毛利率变化情况 87&&&&
图表、近3年**A公司销售毛利率变化情况 88&&&&
图表、近4年**A公司资产负债率变化情况 88&&&&
图表、近3年**A公司资产负债率变化情况 89&&&&
图表、近4年**A公司产权比率变化情况 89&&&&
图表、近3年**A公司产权比率变化情况 90&&&&
图表、近4年**A公司固定资产周转次数情况 90&&&&
图表、近3年**A公司固定资产周转次数情况 90&&&&
图表、近4年**B公司固定资产周转次数情况 91&&&&
图表、近3年**B公司固定资产周转次数情况 92&&&&
图表、近4年**B公司流动资产周转次数变化情况 92&&&&
图表、近3年**B公司流动资产周转次数变化情况 93&&&&
图表、近4年**B公司销售毛利率变化情况 93&&&&
图表、近3年**B公司销售毛利率变化情况 94&&&&
图表、近4年**B公司资产负债率变化情况 94&&&&
图表、近3年**B公司资产负债率变化情况 95&&&&
图表、近4年**B公司产权比率变化情况 95&&&&
图表、近3年**B公司产权比率变化情况 96&&&&
图表、近4年**B公司总资产周转次数变化情况 96&&&&
图表、近3年**B公司总资产周转次数变化情况 97&&&&
图表、近4年**C公司固定资产周转次数情况 98&&&&
图表、近3年**C公司固定资产周转次数情况 98&&&&
图表、近4年**C公司流动资产周转次数变化情况 99&&&&
图表、近3年**C公司流动资产周转次数变化情况 99&&&&
图表、近4年**C公司销售毛利率变化情况 100&&&&
图表、近3年**C公司销售毛利率变化情况 100&&&&
图表、近4年**C公司资产负债率变化情况 101&&&&
图表、近3年**C公司资产负债率变化情况 101&&&&
图表、近4年**C公司产权比率变化情况 102&&&&
图表、近3年**C公司产权比率变化情况 102&&&&
图表、近4年**C公司总资产周转次数变化情况 103&&&&
图表、近3年**C公司总资产周转次数变化情况 103&&&&
图表、近4年**D公司固定资产周转次数情况 105&&&&
图表、近3年**D公司固定资产周转次数情况 106&&&&
图表、近4年**D公司流动资产周转次数变化情况 106&&&&
图表、近3年**D公司流动资产周转次数变化情况 107&&&&
图表、近4年**D公司销售毛利率变化情况 107&&&&
图表、近3年**D公司销售毛利率变化情况 108&&&&
图表、近4年**D公司资产负债率变化情况 108&&&&
图表、近3年**D公司资产负债率变化情况 109&&&&
图表、近4年**D公司产权比率变化情况 109&&&&
图表、近3年**D公司产权比率变化情况 110&&&&
图表、近4年**D公司总资产周转次数变化情况 110&&&&
图表、近3年**D公司总资产周转次数变化情况 111&&&&
图表、近4年**E公司固定资产周转次数情况 112&&&&
图表、近3年**E公司固定资产周转次数情况 113&&&&
图表、近4年**E公司流动资产周转次数变化情况 113&&&&
图表、近3年**E公司流动资产周转次数变化情况 114&&&&
图表、近4年**E公司销售毛利率变化情况 114&&&&
图表、近3年**E公司销售毛利率变化情况 115&&&&
图表、近4年**E公司资产负债率变化情况 115&&&&
图表、近3年**E公司资产负债率变化情况 116&&&&
图表、近4年**E公司产权比率变化情况 116&&&&
图表、近3年**E公司产权比率变化情况 117&&&&
图表、近4年**E公司总资产周转次数变化情况 117&&&&
图表、近3年**E公司总资产周转次数变化情况 118&&&&
图表、我国二巯丁二酸胶囊区域销售市场结构变化 118&&&&
图表、年我国东北地区二巯丁二酸胶囊销售规模分析 119&&&&
图表、东北地区二巯丁二酸胶囊CR5与CR10厂家市场销售份额 120&&&&
图表、年东北地区各规格产品销售比例变化 120&&&&
图表、年我国华北地区二巯丁二酸胶囊销售规模分析 121&&&&
图表、华北地区二巯丁二酸胶囊CR5与CR10厂家市场销售份额 121&&&&
图表、年华北地区各规格产品销售比例变化 122&&&&
图表、年我国中南地区二巯丁二酸胶囊销售规模分析 122&&&&
图表、中南地区二巯丁二酸胶囊CR5与CR10厂家市场销售份额 123&&&&
图表、年中南地区各规格产品销售比例变化 123&&&&
图表、年我国华东地区二巯丁二酸胶囊销售规模分析 124&&&&
图表、华东地区二巯丁二酸胶囊CR5与CR10厂家市场销售份额 124&&&&
图表、年华东地区各规格产品销售比例变化 125&&&&
图表、年我国西北地区二巯丁二酸胶囊销售规模分析 126&&&&
图表、西北地区二巯丁二酸胶囊CR5与CR10厂家市场销售份额 126&&&&
图表、年我国二巯丁二酸胶囊行业销售规模预测 131&&&&
图表、二巯丁二酸胶囊技术应用注意事项分析 137&&&&
图表、二巯丁二酸胶囊项目投资注意事项图 139&&&&
图表、二巯丁二酸胶囊行业生产开发注意事项 142&&&&
图表、二巯丁二酸胶囊销售策略 143&&&&
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当前时间： 11:47:13二巯丁二酸胶囊Chemet(succimer)Capsules-药品说明书与价格-中国新特药网天津站
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二巯丁二酸胶囊Chemet(succimer)Capsules
二巯丁二酸胶囊Chemet(succimer)Capsules
17:42:37&&作者：&&来源：&&浏览次数：12&&文字大小：【】【】【】
简介：二巯丁二酸Succimer
中文别名：
二巯丁二酸 英文别名：
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药品类别：
解毒药 药理药动 药理作用与其他二巯基类化合物相似。某些金属化合物进入体内后，能与细胞酶系统的巯基相结合，抑制酶的活 ...关键字：
二巯丁二酸:Succimer& 中文别名：& 二巯丁二酸&&& 药品类别：& 解毒药 药理作用与其他二巯基类化合物相似。某些金属化合物进入体内后，能与细胞酶系统的巯基相结合，抑制酶的活性。本品有两个巯基，其巯基与金属结合以后，形成不易离解的无毒性络合物由尿排出。从而解除金属对酶系统的作用。 适 应 症 可用作铅、汞、砷、锑中毒的解毒和促排药物。对铜、金、铊、锌也有解毒作用。可提高镍、铂、银、钻、锶金属的LD50和尿中排出量，对有机砷也有解毒作用。 用法用量 口服DMSA胶囊，慢性中毒者每次0.5g，1日3～4次，连续服药3天，间歇4天为一疗程，可用4～5个疗程，以后根据情况酌情停药。 不良反应 毒性低，临床治疗中未见到有不良反应和副作用的报道。 禁忌症 对巯基类药物过敏者禁用。 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 C 4 H 6 O 4 S 2 and molecular weight is 182.2. The meso -structural formula is:
Succimer is a white crystalline powder with an unpleasant, characteristic mercaptan odor and taste. Each CHEMET opaque white capsule for oral administration, contains beads coated with 100 mg of succimer and is imprinted black with CHEMET 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.Succime it forms water soluble chelates and, consequently, increases the urinary excretion of lead. Preclinical Toxicology: In an ongoing six month chronic oral toxicity study in dogs, thrombocytopenia was observed in animals receiving succimer at 80 or 140 mg/kg/day after three months of dosing. Preliminary gross pathology findings in the affected dogs included ecchymoses in a number of organs. No depressed platelet counts were observed in dogs receiving succimer at 10 mg/kg/day for three months. Platelets were not enumerated in previous oral toxicity studies up to 28 days. In those studies, daily doses of succimer up to 200 mg/kg/day did not produce any significant overt toxicity in rats and dogs. However, six and twenty-eight day oral toxicity studies in dogs have shown that doses of 300 mg/kg/ day or higher were toxic and lethal to some dogs. Kidney and gastrointestinal tract were the major target organs for succimer toxicity. Toxicity was manifested by anorexia, emesis, mucoid and/or bloody diarrhea, increased blood urea nitrogen concentration, increased SGPT, SGOT and alkaline phosphatase levels, renal tubular necrosis, purulent nephritis and severe gastrointestinal bleeding and ulceration. Deaths were due to renal failure. Pharmacokinetics:&& In a study performed in healthy adult volunteers, after a single dose of 14 C-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 non-absorbed drug, most of the absorbed drug was excreted by the kidneys. The apparent elimination half-life of the radio-labeled 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- 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 &g/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 CaNa 2 EDTA 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 CaNa 2 EDTA, 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 &g/dL and positive CaNa 2 EDTA lead mobilization tests. Each group of five patients received 350, 233 or 116 mg/m 2 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/m 2 /day CaNa 2 EDTA 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/m 2 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 CaNa 2 EDTA treated group, the cumulative amount of urinary lead excreted was slightly but significantly greater than in the succimer group. After CaNa 2 EDTA, 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. In these studies, after treatment with a dose of 350 mg/m 2 (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 CaNa 2 EDTAIn an attempt to control rebound of blood lead levels, 19 pediatric patients, ages 1-7 years, with blood lead levels of 42-67 &g/dL, were treated with 350 mg/m 2 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/m 2 daily, and the third with 350 mg/m 2 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/m 2 daily experienced rebound during the ensuing two weeks, the group who received the 350 mg/ m 2 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 &g/dL were treated with succimer 350 mg/m 2 every eight hours for five days followed by an additional 19-22 days of therapy at a dose of 350 mg/m 2 every 12 hours. The mean blood lead levels decreased and remained stable at under 15 &g/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. INDICATIONS AND USAGE CHEMET is indicated for the treatment of lead poisoning in pediatric patients with blood lead levels above 45 &g/dL. CHEMET is not indicated for prophylaxis of lead poisoning in a lead-co the use of CHEMET should always be accompanied by identification and removal of the source of the lead exposure. CONTRAINDICATIONS CHEMET should not be administered to patients with a history of allergy to the drug. WARNINGS Keep out of reach of pediatric patients. CHEMET 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/&L and the patient followed closely to document recovery of the ANC to above 1500/&L or to the patient' 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 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 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 therapy in patients with compromised renal function. Limited data suggests that CHEMET 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 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. Information for Patients:&& 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 ). Drug Interaction: CHEMET is not known to interact with other drugs includ interactions have not been systematically studied. Concomitant administration of CHEMET with other chelation therapy, such as CaNa 2 EDTA 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. Carcinogenesis, Mutagenesis and Impairment of Fertility: CHEMET has not been tested for carcinogenic potential in long-term animal studies. CHEMET has not been tested in animals for its effect on fertility and reproductive performance in males and females. 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 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. There are no adequate and well controlled studies in pregnant women. CHEMET 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 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. ADVERSE REACTIONS Clinical experience with CHEMET 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)
Nausea, vomiting, diarrhea, appetite loss, hemorrhoidal symptoms, loose stools, metallic taste in mouth.
Body as a Whole:
Back pain, abdominal cramps, stomach pains, head pain, rib pain, chills, flank pain, fever, flu-like symptoms, heavy head/tired, head cold, headache, moniliasis.
Elevated SGPT, SGOT, alkaline phosphatase, elevated serum cholesterol.
Drowsiness, dizziness, sensorimotor neuropathy, sleepiness, paresthesia.
Skin and Appendages:
Papular rash, herpetic rash, rash, mucocutaneous eruptions, pruritus.
Special Senses:
Cloudy film in eye, ears plugged, otitis media, eyes watery.
Respiratory
Throat sore, rhinorrhea, nasal congestion, cough.
Urogenital
Decreased urination, voiding difficulty, proteinuria increased.
Cardiovascular
Arrhythmia
Heme/Lymphatic:
Mild to moderate neutropenia
Increased platelet count, intermittent eosinophilia.
Musculoskeletal
Kneecap pain, leg pains.
* Does not include neutropenia - see WARNINGS
OVERDOSAGE 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. DOSAGE AND ADMINISTRATION Start dosage at 10 mg/kg or 350 mg/m 2 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/m 2 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)
of CAPSULES
* 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 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' 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 CaNa 2 EDTA with or without BAL may use CHEMET for subsequent treatment after an interval of four weeks. Data on the concomitant use of CHEMET with CaNa 2 EDTA with or without BAL are not available, and such use is not recommended. HOW SUPPLIED 100 mg capsules in bottle of 100 (NDC ) StorageStore between 15°C and 25°C and avoid excessive heat.
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