Comparison between two therapeutic regimens of Succimer and Dipenicillamine plus garlic in Lead poisoning

Background: Poisoning with lead-contaminated opium has become a hot topic in recent years. Because of serious complications of lead poisoning, cessation of lead exposure in addition to chelator therapy is the cornerstone of treatment for symptomatic patients. Majority of patients with addiction-induced lead poisoning belong to low-income level and refuse to even begin the treatment let alone completing the regimen because of financial hardship. Hence, we decided to compare efficacy of standard regimen (Succimer) with a low-cost combination therapy of Dipenicillamin plus Garlic (DPA+Garlic). Materials and Methods: In this retrospective nonrandomized study, outpatient clinical files in two main referral and private toxicology clinics in Mashhad, Iran were reviewed during one year. Total of 97 patients were included in the study and received either Succimer or DPA + Gar, for 19 and 30 days, respectively. Clinical and laboratory data were collected and analyzed by SPSS.Result: Of 79 patients, 42 were treated by DPA+Gar and 37 received Succimer. Mean blood lead level (BLL) of DPA+Gar group at the beginning and at the end of the study was slightly higher than that of the Succimer group (p<0.001 and 0.007, respectively). The means of absolute reduction of BLL in both groups were the same (p=0.196). No serious side effects were observed throughout the treatments with neither Succimer nor the DPA + Gar.Discussion: combination therapy with DPA + Gar had similar efficacy as Succimer. The price of a 19-day treatment with Succimer is 28.66 times higher than that of one-month course of treatment with garlic and DPA. Therefore, in is suggested that in lead-poisoned patients who require chelator therapy and there is either shortage of Succimer or financial burdens, alternative treatment with garlic and DPA could be considered. Further studies with larger population size are recommended.

Keywords:

Lead , Toxicity , Succimer , Dipenicillamin , Garlic , Addiction , Chelator