Pediatric Compounding

Lead Poisoning & Lead Exposure Support

Also called lead poisoning, elevated blood lead level, lead toxicity, plumbism

Lead exposure often causes no symptoms, so a blood test is the only way to know. When a doctor prescribes chelation for high lead levels, Mixwell in Chino, CA prepares it to their order.

Reviewed by Linda Pungpravat, Compounding Pharmacist, RPh Mixwell Compounding Pharmacy, Chino, CA

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Lead Poisoning & Lead Exposure Support

Signs people notice

  • Often no symptoms at all
  • Stomachache or constipation
  • Irritability
  • Headache
  • Tiredness
  • Loss of appetite
  • Learning or behavior problems

Clinical Overview

What is lead poisoning?

Lead poisoning happens when lead builds up in the body, usually from swallowing or breathing in lead dust. Lead can affect nearly every system in the body, especially the brain and nerves. No safe blood lead level in children has been identified [1].

Who is more likely to be exposed

Children under 6 are at highest risk, with the peak between ages 1 and 2, because they spend time on the floor and put hands and objects in their mouths [3]. The most common source is lead based paint and dust in homes built before 1978, when lead paint was banned for use in housing [4].

Adults can be exposed through work or hobbies that involve lead [6]. People who are or may become pregnant are advised to avoid work exposure that raises blood lead to 3.5 µg/dL or higher [6].

How lead levels are checked and managed

A blood test is the only reliable way to find lead poisoning, since most children have no obvious symptoms [1][3]. CDC uses a blood lead reference value of 3.5 µg/dL to identify children with more lead in their blood than most children, and a finger stick result at or above that level should be confirmed with a blood draw from a vein [2].

For most children, the response is removing the lead source and retesting, not medicine. Chelation medicine is reserved for high levels under a doctor's care [7][8].

How Compounding Can Help

Most lead exposure is managed by removing the source and monitoring blood lead, not with medicine [7]. When a doctor prescribes oral chelation for confirmed high lead levels, a compounding pharmacy can prepare it in a form the commercial product does not offer.

  • Succimer capsules in a strength other than the 100 mg commercial capsule, to lower the number of capsules per dose
  • Versions without an ingredient the patient reacts to
  • Quantities matched to the prescribed course

Chelation is not a detox product, and urine tests done after a dose of a chelator have not been scientifically validated [9]. The FDA has warned that over the counter chelation products are unapproved and should be avoided [10].

Common Formulas Prescribers Order for This

Capsule · OralSuccimer 250 mg Oral CapsulesCompounded succimer capsules at 250 mg, prepared in Chino, CA to a prescriber's order for medically supervised treatm...Technical details

Each formula is prepared only with a valid prescription. Your prescriber decides what is appropriate.

What to ask your provider

  • Should my child be tested for lead, and when?
  • Was this a finger stick or a blood draw from a vein, and do we need a venous test to confirm it?
  • Where could the lead be coming from, and can the health department help find it?
  • When should we test again?
  • Is the level high enough that medicine is needed, or is removing the source enough?
  • Are there changes to diet or home cleaning that could help?
Call (909) 378-7301

Common Questions

Is there a safe level of lead in the blood?

No safe blood lead level has been identified in children. CDC uses 3.5 µg/dL as a reference value to find children with more lead than most, so families and providers can act early to remove the source. Lower is always better.

Do children with high lead levels need medicine?

Most children need the lead source removed and follow up testing, not medicine. Chelation is reserved for high levels under a doctor's care, and the approved oral chelator is labeled for levels above 45 µg/dL. In a large trial, chelation at lower levels reduced blood lead but did not improve learning or behavior.

Do home heavy metal detox products or urine tests work?

The FDA has warned that over the counter chelation products are unapproved and should be avoided. Medical toxicologists say urine tests taken after a chelator dose are not scientifically validated and may be harmful. A blood lead test ordered by a provider is the reliable way to check for lead.

Do I need a prescription for a compounded medication?

Yes. Every compounded preparation is made for one patient with a valid prescription from a licensed prescriber, such as a physician, nurse practitioner, dentist, or veterinarian. If you do not have one yet, ask your provider whether a compounded preparation fits your situation, and they can send the order to us.

References
  1. Centers for Disease Control and Prevention. Health effects of lead exposure. Childhood Lead Poisoning Prevention. CDC
  2. Centers for Disease Control and Prevention. Update to CDC's blood lead reference value. 2021. CDC
  3. California Department of Public Health, Childhood Lead Poisoning Prevention Branch. Lead poisoning overview for providers. CDPH
  4. Centers for Disease Control and Prevention. Childhood lead poisoning fact sheet. CDC
  5. Children's Hospital of Philadelphia. Elevated venous blood lead levels clinical pathway: laboratory guidance for lead testing. CHOP
  6. Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health. Blood lead level guidance. CDC NIOSH
  7. CHEMET (succimer) capsules, 100 mg. Prescribing information. DailyMed, U.S. National Library of Medicine. DailyMed label
  8. Rogan WJ, Dietrich KN, Ware JH, et al. The effect of chelation therapy with succimer on neuropsychological development in children exposed to lead. N Engl J Med. 2001;344(19):1421 to 1426. PubMed 11346806
  9. American College of Medical Toxicology. Position statement on post chelator challenge urinary metal testing. J Med Toxicol. 2010;6(1):74 to 75. doi:10.1007/s13181-010-0039-0
  10. U.S. Food and Drug Administration. Questions and answers on unapproved chelation products. FDA
  11. U.S. Health Resources and Services Administration. About the Poison Help line. HRSA Poison Help

Compounded in Chino, CA. Delivered across California.

  • Chino
  • Chino Hills
  • Ontario
  • Pomona
  • Diamond Bar
  • Rancho Cucamonga
  • Eastvale
Mixwell Compounding Pharmacy 13788 Roswell Ave, Ste 158, Chino, CA 91710
(909) 378-7301

Mixwell is a state licensed, non sterile compounding pharmacy and a PCCA member, preparing each formula in a lab built to USP 795 and USP 800 standards. Compounded medications are not reviewed or approved by the FDA and are dispensed only with a valid prescription. We do not prepare sterile products or injectables. Nothing here promises a specific result, and compounded preparations are not presented as superior to commercially available products. Mixwell does not accept insurance. Call for pricing.

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