daybreak [5%:<70 mcg/dL and asymptomatic: IM, IV: 1000 mg/m 2 /day for 5 days Blood lead levels 70 mcg/dL or symptomatic lead poisoning (in conjunction with dimercaprol): Note: Begin treatment with edetate CALCIUM disodium with the second dimercaprol dose: IM, IV: 1,000 mg/m 2 /day or 25 to 50 mg/kg/day for 5 days; a maximum dose of 3,000 mg has been suggested (Howland 2015) Lead encephalopathy (in conjunction with dimercaprol): Note: Begin treatment with edetate CALCIUM disodium with the second dimercaprol dose: IM, IV: 1,500 mg/m 2 /day or 50 to 75 mg/kg/day for 5 days; a maximum dose of 3,000 mg has been suggested (Howland 2015) Lead nephropathy: An alternative dosing regimen reflecting the reduction in renal clearance is based upon the serum creatinine; Note: Repeat regimen monthly until lead levels are reduced to an acceptable level: IM, IV: S cr 2 to 3 mg/dL: 500 mg/m 2 every 24 hours for 5 days S cr 3 to 4 mg/dL: 500 mg/m 2 every 48 hours for 3 doses S cr >4 mg/dL: 500 mg/m 2 once weekly Dosing: Geriatric Refer to adult dosing. Dosing: Pediatric Lead poisoning: Note: For the treatment of high blood lead levels in children, the CDC recommends chelation treatment when blood lead levels are >45 mcg/dL (CDC 2002). The AAP recommends succimer as the drug of choice for the initial management in asymptomatic children when blood lead levels are >45 mcg/dL and> <70 mcg/dL. Edetate CALCIUM disodium can be used in children allergic to succimer (AAP 2005; Chandran 2010). Combination therapy with edetate CALCIUM disodium and dimercaprol is recommended for use in children whose blood lead levels are 70 mcg/dL or in children with lead encephalopathy (AAP 2005; Chandran 2010). Depending upon the blood lead level, additional courses may be necessary; at least 2 to 4 days should elapse before repeat treatment is initiated. Blood lead levels> <70 mcg/dL and asymptomatic: IM, IV: 1,000 mg/m 2 /day for 5 days or 50 mg/kg/day (maximum: 1,000 mg/day) for 5 days (Chandran 2010) Blood lead levels 70 mcg/dL or symptomatic lead poisoning (in conjunction with dimercaprol): Note: Begin treatment with edetate CALCIUM disodium with the second dimercaprol dose: IM, IV: 1,000 mg/m 2 /day or 25 to 50 mg/kg/day (maximum: 1,000 mg/day) for 5 days (Chandran 2010; Howland 2015) Lead encephalopathy (in conjunction with dimercaprol): Note: Begin treatment with edetate CALCIUM disodium with the second dimercaprol dose: IM, IV: 1,500 mg/m 2 /day or 50 to 75 mg/kg/day (maximum: 1,000 mg/day) for 5 days (Chandran 2010; Howland 2015) Dosing: Renal Impairment Dose should be reduced with preexisting mild renal disease. Limiting the daily dose to 1 g in children and 2 g in adults may decrease risk of nephrotoxicity, although larger doses may be needed in the treatment of lead encephalopathy (Howland 2015). Reconstitution For IV infusion, dilute total daily dose into 250-500 mL of 0.9% sodium chloride or D 5 W. Concentrations >0.5% (5 mg/mL) should be avoided. Procaine or lidocaine may be added to solutions given by IM injection. Administration For IM or IV use; IV is generally preferred, however, the IM route is preferred when cerebral edema is present. IV infusion: Administer the daily dose as a diluted solution over 8 to 12 hours or continuously over 24 hours (Howland 2015) For IM injection: Daily dose should be divided into 2 to 3 equal doses spaced 8 to 12 hours apart. Procaine hydrochloride or lidocaine may be added to the edetate CALCIUM disodium to minimize pain at injection site. Administer by deep IM injection. When used in conjunction with dimercaprol, inject into a separate site. Storage Store at 25 C (77 F); excursion permitted to 15 C to 30 C (59 F to 86 F). Drug Interactions BCG (Intravesical): Myelosuppressive Agents may diminish the therapeutic effect of BCG (Intravesical). Avoid combination CloZAPine: Myelosuppressive Agents may enhance the adverse/toxic effect of CloZAPine. Specifically, the risk for neutropenia may be increased. Monitor therapy Deferiprone: Myelosuppressive Agents may enhance the neutropenic effect of Deferiprone. Avoid combination Dipyrone: May enhance the adverse/toxic effect of Myelosuppressive Agents. Specifically, the risk for agranulocytosis and pancytopenia may be increased Avoid combination Insulins: Edetate CALCIUM Disodium may enhance the hypoglycemic effect of Insulins. Monitor therapy Promazine: May enhance the myelosuppressive effect of Myelosuppressive Agents. Monitor therapy Test Interactions If edetate CALCIUM disodium is given as a continuous IV infusion, stop the infusion for at least 1 hour before blood is drawn for lead concentration to avoid a falsely elevated value Adverse Reactions Frequency not defined. Cardiovascular: Cardiac arrhythmia, ECG changes, hypotension, local thrombophlebitis (IV infusion when concentration >5 mg/mL) Central nervous system: Chills, fatigue, headache, malaise, numbness, paresthesia Dermatologic: Cheilosis, dermatitis, skin rash Endocrine & metabolic: Glycosuria, hypercalcemia, hypokalemia, iron deficiency (with chronic therapy), magnesium deficiency (with chronic therapy), polydipsia, zinc deficiency (with chronic therapy) Gastrointestinal: Anorexia, gastrointestinal irritation, nausea, vomiting Genitourinary: Nephrosis, nephrotoxicity, occult blood in urine, proteinuria, urinary frequency, urinary urgency Hematologic & oncologic: Anemia, bone marrow depression (transient) Hepatic: Decreased serum alkaline phosphatase, increased liver enzymes (mild) Local: Pain at injection site (intramuscular) Neuromuscular & skeletal: Arthralgia, myalgia, tremor Ophthalmic: Lacrimation Renal: Renal tubular necrosis Respiratory: Nasal congestion, sneezing Miscellaneous: Fever ALERT: U.S. Boxed Warning Cerebral edema: Edetate calcium disodium is capable of producing toxic effects that can be fatal. Lead encephalopathy is relatively rare in adults, but occurs more often in pediatric patients in whom it may be incipient and thus overlooked. The mortality rate in pediatric patients has been high. Patients with lead encephalopathy and cerebral edema may experience a lethal increase in intracranial pressure following, intravenous (IV) infusion; the intramuscular (IM) route is preferred for these patients. In cases where the IV route is necessary, avoid rapid infusion. The dosage schedule should be followed and at no time should the recommended daily dose be exceeded. Warnings/Precautions Concerns related to adverse effects: Arrhythmias: Monitor for arrhythmias and ECG changes during IV therapy Nephrotoxicity: Edetate CALCIUM disodium is potentially nephrotoxic. Renal tubular acidosis and fatal nephrosis may occur, especially with high doses; do not exceed the recommended daily dose. If anuria, increasing proteinuria, or hematuria occurs during therapy, discontinue use. Minimize nephrotoxicity by providing adequate hydration, establishment of good urine output, avoidance of excessive doses, and limit continuous administration to 5 days. Disease-related concerns: Cerebral edema: [US Boxed Warning]: Use with extreme caution in patients with lead encephalopathy and cerebral edema. In these patients, IV infusion has been associated with a lethal increase in intracranial pressure; IM injection is preferred. Lead poisoning: Investigate, identify, and remove sources of lead exposure prior to treatment. Primary care providers should consult experts in chemotherapy of lead toxicity before using chelation drug therapy. Do not permit patients to re-enter the contaminated environment until lead abatement has been completed. Renal impairment: Use with caution in patients with renal impairment; reduced dose recommended. Other warnings/precautions: Potential for name confusion: Exercise caution in the ordering, dispensing, and administration of this drug. Edetate CALCIUM disodium (CaEDTA) may be confused with edetate disodium (Na 2 EDTA) (not commercially available in the US or Canada). Fatal hypocalcemia may result if edetate disodium is used for the treatment of lead poisoning instead of edetate CALCIUM disodium (Baxter 2008). The CDC and FDA recommend that edetate disodium should never be used for chelation therapy (especially in children) (Mitka 2008). Death has occurred following the use of edetate disodium for chelation therapy in pediatric patients with autism (Baxter 2008). Monitoring Parameters Urinary output; urinalysis; renal function, hepatic function, serum electrolytes (baseline and daily [severe lead poisoning] or at days 2 and 5 [less severe lead poisoning]); ECG (with IV therapy); blood lead levels (baseline and 7-21 days after completing chelation therapy); hemoglobin or hematocrit; iron status; free erythrocyte protoporphyrin or zinc protoporphyrin; neurodevelopmental changes Pregnancy Risk Factor B Pregnancy Considerations Adverse events were observed in some animal reproduction studies; there are no well controlled studies of edetate CALCIUM disodium in pregnant women. Lead is known to cross the placenta in amounts related to maternal plasma levels. Prenatal lead exposure may be associated with adverse events such as spontaneous abortion, preterm delivery, decreased birth weight, and impaired neurodevelopment. Some adverse outcomes may occur with maternal blood lead levels> <10 mcg/dL. In addition, pregnant women exposed to lead may have an increased risk of gestational hypertension. Consider chelation therapy in pregnant women with confirmed blood lead levels 45 mcg/dL (pregnant women with blood lead levels 70 mcg/dL should be considered for chelation regardless of trimester). Alternatives to edetate CALCIUM disodium may be indicated and consultation with experts in lead poisoning and high-risk pregnancy is recommended. Encephalopathic pregnant women should be chelated regardless of trimester (CDC 2010). Patient Education Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?) Patient may experience nausea, vomiting, lack of appetite, increased thirst, headache, dry lips, muscle pain, joint pain, sneezing, rhinorrhea, tearing, or irritation at the injection site. Have patient report immediately to prescriber signs of kidney problems (urinary retention, hematuria, change in amount of urine passed, or weight gain), signs of high calcium (weakness, confusion, fatigue, headache, nausea and vomiting, constipation, or bone pain), abnormal heartbeat, tachycardia, loss of strength and energy, severe dizziness, passing out, tremors, numbness, or tingling (HCAHPS). Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions. Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients. Next Interactions Print this page Add to My Med List More about edetate calcium disodium Side Effects During Pregnancy Dosage Information Drug Interactions Support Group En Español 0 Reviews Add your own review/rating Drug class: antidotes Consumer resources Edetate calcium disodium Professional resources Edetate Calcium Disodium (AHFS Monograph) Other brands: Calcium Disodium Versenate Related treatment guides Lead Poisoning, Mild Lead Poisoning, Severe> ]} Drug Status Rx Availability Prescription only B Pregnancy Category No proven risk in humans N/A CSA Schedule Not a controlled drug Approval History Drug history at FDA Edetate calcium disodium Rating No Reviews - Be the first! No Reviews - Be the first! Not Rated - Be the first! Drug Class Antidotes Related Drugs antidotes naltrexone , atropine , naloxone , acetylcysteine , leucovorin Lead Poisoning, Mild Calcium Disodium Versenate , More... Lead Poisoning, Severe Calcium Disodium Versenate , Chemet , succimer , More...} } you don't have any
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