DimercaprolDMSA

Dimercaprol, also known as British Anti-Lewisite (BAL), is a chelating agent used primarily for the treatment of heavy metal poisoning, including arsenic, mercury, and gold. It was originally developed during World War II as an antidote to chemical warfare agents. Chemically, it is a small, oily, water-soluble compound containing two thiol (-SH) groups, which confer its ability to bind heavy metals and facilitate their excretion from the body.

Dimercaprol is administered via intramuscular injection and works by forming stable, nontoxic complexes with heavy metals, preventing their interaction with vital biological molecules. It enhances the renal elimination of the bound metals, reducing toxicity. However, its use is limited by side effects such as hypertension, tachycardia, nausea, and local pain at the injection site.

DMSA (dimercaptosuccinic acid) is a water-soluble analog of dimercaprol, developed as an oral chelating agent. Structurally, DMSA features two thiol groups attached to a succinic acid backbone, enabling it to chelate heavy metals effectively. DMSA is primarily used for treating lead poisoning, especially in children, and is favored for its oral administration, reduced side effects, and better patient compliance.

Both agents are part of chelation therapy, which is a medical treatment strategy for heavy metal poisoning. The choice between dimercaprol and DMSA depends on the type of metal involved, the severity of poisoning, and the patient's health condition. While effective, chelation therapy requires careful monitoring to prevent potential adverse effects and ensure safe elimination of toxic metals.