DOSE IN ASYMPTOMATIC ADULTS AND PEDIATRIC PATIENTS WHOSE BLOOD LEAD LEVEL IS < 70 MCG/DL BUT > 20 MCG/DL (WORLD HEALTH ORGANIZATION RECOMMENDED UPPER ALLOWABLE LEVEL) IS 1000 MG/M2/DAY IV OR IM.
ADULTS WITH LEAD NEPHROPATHY:
500 MG/M2 EVERY 24 HOURS FOR 5 DAYS WITH SERUM CREATININE LEVELS OF 2-3 MG/DL, EVERY 48 HOURS FOR 3 DOSES WITH CREATININE LEVELS OF 3-4 MG/DL, AND ONCE WEEKLY WITH CREATININE LEVELS ABOVE 4 MG/DL. THESE REGIMENS MAY BE REPEATED AT ONE MONTH INTERVALS.
INTRAVENOUS ADMINISTRATION:
ADD THE TOTAL DAILY DOSE OF CALCIUM DISODIUM VERSENATE (1000 MG/M2/DAY) TO 250-500 ML OF 5% DEXTROSE OR 0.9% SODIUM CHLORIDE INJECTION. THE TOTAL DAILY DOSE SHOULD BE INFUSED OVER A PERIOD OF 8-12 HOURS. CALCIUM DISODIUM VERSENATE INJECTION IS INCOMPATIBLE WITH 10% DEXTROSE, 10% INVERT SUGAR IN 0.9% SODIUM CHLORIDE, LACTATE MOLAR SODIUM LACTATE INJECTIONS, AND WITH INJECTABLE AMPHOTERICIN B AND HYDRALAZINE HYDROCHLORIDE.
INTRAMUSCULAR ADMINISTRATION
THE TOTAL DAILY DOSAGE (1000 MG/M2/DAY) SHOULD BE DIVIDED INTO EQUAL DOSES SPACED 8-12 HOURS APART. LIDOCAINE OR PROCAINE SHOULD BE ADDED TO THE CALCIUM DISODIUM VERSENATE INJECTION TO MINIMIZE PAIN AT THE INJECTION SITE. THE FINAL LIDOCAINE OR PROCAINE CONCENTRATION OF 5 MG/ML (0.5%) CAN BE OBTAINED AS FOLLOWS: 0.25 ML OF 10% LIDOCAINE SOLUTION PER 5 ML (ENTIRE CONTENT OF AMPUL) CONCENTRATED CALCIUM DISODIUM VERSENATE; 1 ML OF 1% LIDOCAINE OR PROCAINE SOLUTION PER ML OF CONCENTRATED CALCIUM DISODIUM VERSENATE. WHEN USED ALONE, REGARDLESS OF METHOD OF ADMINISTRATION, CALCIUM DISODIUM VERSENATE SHOULD NOT BE GIVEN AT DOSES LARGER THAN THOSE RECOMMENDED.
WHEN USED ALONE, MAY AGGRAVATE SYMPTOMS IN PATIENTS WITH VERY HIGH BLOOD LEAD LEVELS. WHEN THE BLOOD LEAD LEVEL IS > 70 MCG/DL OR CLINICAL SYMPTOMS CONSISTENT WITH LEAD POISONING ARE PRESENT, IT IS RECOMMENDED THAT CALCIUM DISODIUM VERSENATE BE USED IN CONJUNCTION WITH BAL (DIMERCAPROL). PROPER HYDRATION OF THE PATIENT IS ALSO IMPORTANT TO MAINTAIN URINE FLOW AS IT IS EXCRETED THROUGH KIDNEYS.
THERAPY OF LEAD POISONING IN ADULTS AND PEDIATRIC PATIENTS IS CONTINUED OVER A PERIOD OF FIVE DAYS. THERAPY IS THEN INTERRUPTED FOR 2 TO 4 DAYS TO ALLOW REDISTRIBUTION OF THE LEAD AND TO PREVENT SEVERE DEPLETION OF ZINC AND OTHER ESSENTIAL METALS. TWO COURSES OF TREATMENT ARE USUALLY EMPLOYED; HOWEVER, IT DEPENDS ON SEVERITY OF THE LEAD TOXICITY AND THE TOLERANCE OF THE DRUG.