DMSA
| See Also | Food Supplements |
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DMSA is the common name for dimercaptosuccinic acid, also known as dimethylsuccinic acid, or disodium monomethanearsonate. It is commonly used in chelation therapy with individuals that have elevated levels of mercury or lead.
Background
DMSA was initially studied in China, Japan, and Russia in the 1950s for treating heavy metal toxicity, and in the 1970s gained popularity in Europe and the USA. DMSA is commonly used in individuals with elevated levels of either mercury or lead as an alternative to BAL or D-penicillamine as it has a significantly better side effect profile.[1] DMSA has a relatively short half life, about 60 minutes, and concentrates predominately in extracellular fluid. Although its pharmacodynamics are not completely understood, its suggested that the majority of its chelating action occurs through the kidney.[2]
Uses
- Autism
- DMSA has been shown to improve behavioural symptoms in autism spectrum disorder.[4]
- Diagnostics
- DMSA is commonly used in provocative urinary analysis testing. Urine is tested pre and post administration of DMSA to identify total body burden of heavy metals.[5]
| Agent | Half Life | Collection Period |
| EDTA | ~1 hr | 6 - 24 hrs |
| DMPS (IV) | ~1 hr | 2 - 6 hrs |
| DMPS (oral) | ~9 hrs | 6 - 9 hrs |
| DMSA | ~4 hrs | 6 - 9 hrs |
Prescribing considerations
- Route of Administration
- Micronutrient Depletion
- Adjuncts
- Some studies suggest that combining vitamin C, or EDTA with DMSA may increase lead excretion.[5]
- Whey protein, due to its cysteine and branched chain amino acid content, can assist in elimination of heavy metals and play a hepatoprotective role when combined with DMSA.[5]
Safety
- Kidney and Liver Function
- Caution should be shown with use in patients with impaired liver or kidney function.[6]
- Side Effects
- Side effects include GI symptoms, rash, headaches, dizziness, and increased liver function tests.[6]
- DMSA contains sulhydryl compounds with will make urine smell sulfourous.[5]
Efficacy
Lead
- DMSA is effective in increasing urinary excretion of lead, and decreasing blood levels of lead.[2]
Mercury
Other Heavy Metals
References
- ↑ Baum CR (2007) Shannon: Haddad and Winchester’s Clinical Management of Poisoning and Drug Overdose, 4th ed Section G Toxic Metals and Minerals Saunders.
- ↑ 2.0 2.1 2.2 2.3 Bradberry S, Vale A (2009) A comparison of sodium edetate and succimer (DMSA) in the treatment of inorganic lead poisoning. Clin Toxicol 47(9):841-58.
- ↑ Hall AH, Shannon MW (2007) Shannon: Haddad and Winchester’s Clinical Management of Poisoning and Drug Overdose 4th ed Chap 75 Other Heavy Metals Saunders
- ↑ Adams JB, Baral M, Mitchell J, Geis E, Ingram J, Hensley A, Zappia I, Newmark S, Gehn E, Rubine RA, Mitchell K, Bradstreet J, El-Dahr J (2009) Safety and efficacy of oral DMSA therapy for children with autism spectrum disorder: part B behavioral results. BMC Clin Pharm 9:17 p1-9.
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 Miller AL (1998) Dimercaptosuccinic Acid (DMSA), A Non-Toxic, Water-Soluble Treatment For Heavy Metal Toxicity Alt Med Rev 3(3):199-207
- ↑ 6.0 6.1 Lee CKK, Tschudy MM, Arcara KM (2011) Johns Hopkins: The Harriet Lane Handbook, 19th ed Chap 29 Drug Doses Mosby
