B.A.L.INJ

B.A.L.INJ is a traditional chelating agent developed by British biochemists at Oxford University during World War II. It was developed as an experimental antidote against the arsenic-based poison gas Lewisite. It has been used clinically since 1949 in arsenic, cadmium and mercury poisoning. In addition, it has in the past been used for the treatment of Wilson's disease, a genetic disorder in which the body tends to retain copper. B.A.L.INJ is a potentially toxic drug, and its use may be accompanied by multiple side effects.

Intramuscular

Heavy metal poisoning

Adult: 400-800 mg on the 1st day followed by 200-400 mg on the 2nd and 3rd day, then 100-200 mg on the 4th and subsequent days, all in divided doses.

Hepatic impairment: Contraindicated.

Intramuscular

Adjunct in lead poisoning

Adult: In conjunction w/ sodium calcium edetate: Initially, 4 mg/kg followed by 3-4 mg/kg at 4-hrly intervals.

Maintenance: 2-7 days.

Hepatic impairment: Contraindicated.

B.A.L.INJ is a chelating (KEE-late-ing) agent that is used to remove a heavy metal (such as lead or mercury) from the blood.

B.A.L.INJ is used to treat arsenic, gold, or mercury poisoning. It is also used together with another medicine called edetate disodium (EDTA) to treat lead poisoning.

B.A.L.INJ may also be used for purposes not listed in this medication guide.

By deep intramuscular injection only. For mild arsenic or gold poisoning, 2.5 mg/kg of body weight four times daily for two days, two times on the third day, and once daily thereafter for ten days; for severe arsenic or gold poisoning, 3 mg/kg every four hours for two-days, four times on the third day, then twice daily thereafter for ten days. For mercury poisoning, 5 mg/kg initially, followed by 2.5 mg/kg one or two times daily for ten days. For acute lead encephalopathy, 4 mg/kg body weight is given alone in the first dose and thereafter at four-hour intervals in combination with Edetate Calcium Disodium Injection USP administered at a separate site. For less severe poisoning the dose can be reduced to 3 mg/kg after the first dose. Treatment is maintained for two to seven days depending on clinical response. Successful treatment depends on beginning injections at the earliest possible moment and on the use of adequate amounts at frequent intervals. Other supportive measures should always be used in conjunction with B.A.L.INJ (B.A.L.INJ Injection USP) therapy.

B.A.L.INJ should be inspected visually for particulate matter and discoloration prior to administration.

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What is the most important information I should know about B.A.L.INJ?

B.A.L.INJ (B.A.L.INJ Injection USP) is contraindicated in most instances of hepatic insufficiency with the exception of postarsenical jaundice. The drug should be discontinued or used only with extreme caution if acute renal insufficiency develops during therapy.

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What other drugs will affect B.A.L.INJ?

Effects may be increased by drugs with antimuscarinic effect such as; some antihistamines; phenothiazines; antipsychotics; TCAs; MAOIs or parasympathomimetics.

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What are the possible side effects of B.A.L.INJ?

One of the most consistent responses to B.A.L.INJ Injection USP is a rise in blood pressure accompanied by tachycardia. This rise is roughly proportional to the dose administered. Doses larger than those recommended may cause other transitory signs and symptoms in approximate order of frequency as follows: (1) nausea and, in some instance, vomiting; (2) headache; (3) a burning sensation in the lips, mouth and throat; (4) a feeling of constriction, even pain, in the throat, chest, or hands; (5) conjunctivitis, lacrimation, blepharal spasm, rhinorrhea, and salivation; (6) tingling of the hands; (7) a burning sensation in the penis; (8) sweating of the forehead, hands and other areas; (9) abdominal pain; and (10) occasional appearance of painful sterile abscesses. Many of the above symptoms are accompanied by a feeling of anxiety, weakness, and unrest and often are relieved by administration of antihistamine.