BAL In Oil

• Akorn, Inc.

• Taylor Pharmaceuticals

BAL In Oil is part of the drug class:

• Antidotes

In a poisoning situation it may not be possible to tell your caregivers about your health conditions. Make sure any doctor caring for you afterward knows you have received this medicine.

Follow your doctor's instructions about any restrictions on food, beverages, or activity.

Absorption

Bioavailability

Peak plasma concentrations attained 30–60 minutes following IM injection.a

Slowly absorbed through the skin following topical application.a

Distribution

Extent

Distributed into all tissues (mainly in the intracellular space) including the brain, with the highest concentrations in the liver and kidneys.a

Elimination

Metabolism

Dimercaprol (not excreted as the dimercaprol-metal complex) is rapidly metabolized to inactive products.a

Some drug may be excreted as a glucuronide conjugate.a In humans, metabolism and excretion is probably complete within 4 hours.a

Elimination Route

Excreted in urine and feces via bile.a

• Contains sulfhydryl groups that form heterocyclic ring complexes with heavy metals (particularly arsenic, mercury, and gold).a b

• These complexes prevent or reverse the binding of metallic cations to body ligands such as essential sulfhydryl-dependent enzymes.a b Does not protect sulfhydryl enzymes from metals, such as selenium, that inhibit such enzymes by an oxidation process.a

• If the affinity of the metal for dimercaprol is greater than that for enzymes, a mercaptide is formed, which can be excreted from the body.

• Dimercaprol-metal complex can dissociate (particularly in an acid medium or as the level of dimercaprol declines) or be oxidized, thus releasing the metal to exert its toxic effects again.a

• Has little affinity for the essential trace metals of the body (except copper); does not usually produce trace metal depletion syndromes.a However, may interfere with normal accumulation of iodine by the thyroid.a

BAL in Oil (Dimercaprol Injection USP) is indicated in the treatment of arsenic, gold and mercury poisoning. It is indicated in acute lead poisoning when used concomitantly with Edetate Calcium Disodium Injection USP.

Dimercaprol Injection USP is effective for use in acute poisoning by mercury salts if therapy is begun within one or two hours following ingestion. It is not very effective for chronic mercury poisoning.

Dimercaprol Injection USP is of questionable value in poisoning caused by other heavy metals such as antimony and bismuth. It should not be used in iron, cadmium, or selenium poisoning because the resulting dimercaprol-metal complexes are more toxic than the metal alone, especially to the kidneys.

Dimercaprol Injection USP is not a controlled substance listed in any other Drug Enforcement Administration schedules. Its use is not known to lead to dependence or abuse.

Dosage exceeding 5 mg/kg will usually be followed by vomiting, convulsions and stupor, beginning within 30 minutes and subsiding within 6 hours following injection.

AMER. HOSP. FORM. SERV., 64:00, Amer. Soc. Hosp. Pharm., 1977.

• If you need to store Bal in Oil at home, talk with your doctor, nurse, or pharmacist about how to store it.