Calcium disodium EDTA
Administration
- Type: Chelating agent
- Dosage Forms: injection (200 mg/mL)
- Routes of Administration: IV (preferred), IM (with procaine to reduce pain)
- Common Trade Names: Calcium Disodium Versenate, CaNa2EDTA
Adult Dosing
Lead poisoning (symptomatic or BLL >70 mcg/dL)
- 1000-1500 mg/m²/day IV as continuous infusion or divided q6-12h
- Maximum: 3 g/day (or 50 mg/kg/day if using weight-based dosing)
- Duration: 5 days; may repeat after 2-4 day drug-free interval if needed
- For lead encephalopathy: use in combination with dimercaprol (BAL); start BAL 4 hours before CaNa2EDTA
IM dosing (if IV not available)
- Same dose; mix with 1% procaine to reduce injection pain
Pediatric Dosing
Lead poisoning (BLL ≥45 mcg/dL or symptomatic)
- 1000-1500 mg/m²/day IV as continuous infusion or divided q6-12h
- Maximum: 50 mg/kg/day
- Duration: 5 days; may repeat after 2-4 day drug-free interval
- For lead encephalopathy: always use with dimercaprol (BAL); start BAL 4 hours before CaNa2EDTA
Special Populations
Pregnancy Rating
- B
Lactation risk
- Unknown; use caution
Renal Dosing
- Adult: Contraindicated in anuria; reduce dose in renal impairment; monitor renal function closely
- Pediatric: Same as adult
Hepatic Dosing
- Adult: No specific adjustment
- Pediatric: No specific adjustment
Contraindications
- Allergy to class/drug
- Anuria or severe renal disease
- Hepatorenal syndrome
- Active hepatitis
Adverse Reactions
Serious
- Nephrotoxicity (renal tubular necrosis — dose-dependent; monitor BUN/Cr daily)
- Severe hypocalcemia (if disodium EDTA used instead — ensure CALCIUM disodium EDTA is used)
- Cardiac arrhythmias (from electrolyte shifts)
- Bone marrow suppression
Common
- Nausea, vomiting
- Injection site pain (IM)
- Fever, chills
- Fatigue, malaise
- Transient hypotension
- Zinc depletion (with prolonged courses)
Pharmacology
- Half-life: 20-60 minutes (IV)
- Metabolism: Not metabolized
- Excretion: Renal (>95% excreted as chelate complex within 24 hours)
Mechanism of Action
- Forms stable, water-soluble chelate complex with divalent and trivalent metals (especially lead)
- Chelate complex is excreted renally, reducing body lead burden
- Does not cross the blood-brain barrier significantly (which is why BAL is used concurrently for encephalopathy)
Comments
- CRITICAL: Ensure CALCIUM disodium EDTA (CaNa2EDTA) is used — NOT disodium EDTA (Na2EDTA), which causes fatal hypocalcemia
- For lead encephalopathy, always start dimercaprol (BAL) 4 hours before CaNa2EDTA to prevent redistribution of lead into the brain
- Monitor serum BUN, creatinine, electrolytes, CBC, and urinalysis daily during treatment
- Adequate hydration is essential but avoid overhydration in encephalopathic patients (risk of cerebral edema)
- A "provocation test" (single dose followed by urine lead measurement) is no longer recommended
- Consider succimer (DMSA) as oral alternative for BLL 45-69 mcg/dL without encephalopathy
Indications by Condition
The following table is automatically generated from disease/condition pages across WikEM.