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Latest Edit: Hector 2014-03-17 (EDT)

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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.


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]


  • Autism
  • DMSA has been shown to improve behavioural symptoms in autism spectrum disorder.[4]
  • Diagnostics
Comparison of Provocative Agents
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
  • DMSA is taken orally. As EDTA is used intravenously, in patients that can tolerate oral medications, DMSA is a preferable alternative.[2]
  • Micronutrient Depletion
  • Adjuncts


  • 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]



  • DMSA is effective in increasing urinary excretion of lead, and decreasing blood levels of lead.[2]


  • When compared to DMPS, and D-penicillamine, DMSA has been shown to more effectively remove mercury from the blood, liver, brain, spleen, lungs, muscle, and bone. DMSA was less effective than DMPS at removing mercury from the kidneys.[5]

Other Heavy Metals

  • Clinical studies have demonstrated that DMSA is safe and effective in decreasing total body burden of mercury, arsenic, and cadmium. [5]


  1. 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. 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.
  3. 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
  4. 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. 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. 6.0 6.1 Lee CKK, Tschudy MM, Arcara KM (2011) Johns Hopkins: The Harriet Lane Handbook, 19th ed Chap 29 Drug Doses Mosby