Lead Poisoning & Lead Exposure Support
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Succimer 250 mg Oral Capsules

Capsule Formulation

Compounded succimer capsules at 250 mg, prepared in Chino, CA to a prescriber's order for medically supervised treatment of confirmed lead poisoning.

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

  • USP <795> compliant
  • USP <800> hazardous drug lab
  • PCCA member

Clinical Advantages

  • Custom strength available
  • Weight based dosing
  • Dye free option
  • Non sterile preparation

How It Works

What is Succimer 250 mg Oral Capsules?

Succimer 250 mg Oral Capsules are a compounded strength of succimer, an oral chelating agent that binds lead so it can be excreted in urine. They are prepared by prescription for medically supervised treatment of confirmed lead poisoning, when the prescriber needs a strength the 100 mg commercial capsule does not offer.

How it works

  1. Succimer binds lead in the blood, forming a water soluble complex that the kidneys excrete [1].
  2. Treatment lowers blood lead, which is why the source of lead is removed first so levels do not rise again [1].
  3. Succimer does not cross the blood brain barrier and is not indicated for lead encephalopathy [1].
  4. Dosing is weight based, so the capsule strength determines how many capsules make up each dose.

When prescribers choose it

  • Medical toxicologists and occupational medicine physicians treating adults with high blood lead
  • Pediatricians and toxicologists dosing older children, where 100 mg capsules add up quickly
  • Poison center directed treatment that calls for a specific capsule strength
  • Prescribers whose patients react to an ingredient in the commercial capsule

Clinical Details

What does the evidence show?
  • Chemet, the FDA approved succimer product, is indicated for lead poisoning in children aged 1 year and older with blood lead levels above 45 mcg/dL. Its labeling states it is not indicated to prevent lead poisoning in a lead containing environment [1].
  • Rogan and colleagues (2001, New England Journal of Medicine) randomized 780 children aged 12 to 33 months with blood lead levels of 20 to 44 mcg/dL to succimer or placebo. Succimer lowered blood lead but did not improve scores on tests of cognition, behavior, or neuropsychological function, and the authors concluded chelation is not indicated for children at those levels [2].
  • Recommendations for adult lead exposure from Kosnett and colleagues (2007, Environmental Health Perspectives) state that chelation may have an adjunctive role for highly exposed adults with symptomatic lead intoxication, but is not recommended for asymptomatic individuals with low blood lead concentrations [3].
  • The American College of Medical Toxicology states that urine metal testing after a chelator challenge has not been scientifically validated, has no demonstrated benefit, and may be harmful when used to assess or treat suspected metal poisoning [4].

Findings come from the cited studies and do not promise any individual outcome.

Why is it compounded, and how is it typically used?

Why it is compounded

Succimer is sold in the United States as a 100 mg capsule [1]. Dosing is weight based, so at the labeled 10 mg/kg a 70 kg patient would need seven 100 mg capsules per dose, three times a day. A compounded 250 mg capsule lowers that pill count. Federal law restricts compounding copies of commercially available drugs unless the prescriber determines a change produces a significant difference for the patient, and that reason belongs on the prescription [5].

Dosage forms and strengths

  • 250 mg capsules, or another strength the prescriber sets
  • Dye free capsules on request
  • Quantities matched to the prescribed course, since uninterrupted dosing beyond 3 weeks is not established as safe [1]
  • Excipients chosen to avoid an ingredient the patient reacts to

Treatment follows confirmed blood lead testing and removal of the lead source [1]. Dosing, monitoring, and duration are the prescriber's decision.

How Mixwell prepares it

Mixwell compounds these capsules in Chino, California under USP 795 standards for non sterile preparations [6]. Our pharmacist confirms the strength, quantity, and course with the prescriber before compounding, and the capsules are dispensed in a tight, light resistant container, as the approved labeling specifies for succimer [1]. Batch records document every preparation, and finished capsules ship across California.

Safety information

Succimer requires laboratory monitoring. Labeling calls for a complete blood count, liver enzymes, and kidney function before treatment, and weekly blood counts during it, with treatment interrupted if neutrophils fall below 1,200/mcL or liver enzymes rise above 5 times the upper limit of normal [1]. Gastrointestinal symptoms and rising liver enzymes occur in about 10% of patients, and rash in about 4% [1].

Succimer may cause fetal harm, and patients should stay well hydrated during treatment [1]. It is not given with other chelating agents, and it can cause false positive urine ketone results [1]. Chelation is not a substitute for removing the source of lead, and it is not recommended for people without symptoms and with low blood lead [1][3]. Patient selection, dosing, monitoring, and duration are the prescriber's responsibility.

References
  1. CHEMET (succimer) capsules, 100 mg. Prescribing information. DailyMed, U.S. National Library of Medicine. DailyMed label
  2. 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
  3. Kosnett MJ, Wedeen RP, Rothenberg SJ, et al. Recommendations for medical management of adult lead exposure. Environ Health Perspect. 2007;115(3):463 to 471. doi:10.1289/ehp.9784
  4. 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
  5. U.S. Food and Drug Administration. Compounding when drugs are on FDA's drug shortages list. FDA human drug compounding
  6. United States Pharmacopeia. General Chapter 795, Pharmaceutical Compounding: Nonsterile Preparations. USP NF. Official November 1, 2023.

What to include on the prescription

  • APIs and strengths
  • Base or vehicle
  • Quantity
  • Directions for use
  • Refills
  • Allergies or dye free needs
Call (909) 378-7301 Fax (909) 378-7071
Commonly prescribed for Lead Poisoning & Lead Exposure Support

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

Compounded medications are not reviewed or approved by the FDA. Dispensed only with a valid prescription. Mixwell is a non sterile pharmacy and does not prepare sterile products or injectables. Compounded preparations are not presented as superior to commercially available products, and nothing here promises a specific result. Mixwell does not accept insurance. Call for pricing.

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Want to learn more about Succimer 250 mg Oral Capsules

Are you a healthcare provider or patient in Chino, Chino Hills, Ontario, Eastvale, Rancho Cucamonga, or Upland? Mixwell Pharmacy provides specialized pharmaceutical support throughout San Bernardino, Los Angeles, and Orange Counties. Contact our Chino laboratory to learn how we facilitate customized Succimer 250 mg Oral Capsulesfor practitioners across Southern California.

(909) 378-7301

Serving Los Angeles County, Orange County, San Bernardino County, Riverside County, Ventura County, and the Inland Empire