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Chelating Mercury toxicity with DMSA -possible drug interactions or side effets with meds?
Jan 2, 2004

I am on a Combiver/Viracept regimen and have recently discovered high levels of Mercury, Arseni and Cadmium in a hair sample analysis. An alternative practitioner is recommending chelating with DMSA -do you know if there are any possible interactions or side effects with meds or otherwise?

Response from Dr. Moyle

Meso-2,3-dimercaptosuccinic acid (DMSA) is a sulfhydryl-containing, water-soluble, non-toxic, orally-administered metal chelator which has been in use as an antidote to heavy metal toxicity since the 1950s.It has been investigated in the medical setting as chelation therapy for lead. In a placebo controlled trial it was ineffective (O'Connor ME, Rich D. Children with moderately elevated lead levels: is chelation with DMSA helpful?Clin Pediatr (Phila). 1999;38:325-31.), although others have reported benefit. Uncontrolled adult studies over 19 days or more have also seen lead levels fall. Animal studies have reported reductions in cadmium, arsenic and mercury during DMSA use. Its seems generally well tolerated. Mercury is derived from amalgum fillings and some seafood prodcuts. Eliminating these may enable mervury levels to fall naturally. Assessment of total heavy metal exposure from hair is a very inexact approach. Studies with zinc, manganese did not find correlation with exposure or blood levels although hair sampling may be useful for assessing recent mercury exposure.

If you use DMSA, it is recommended that you work with a Doc that has used it in the past and it is recommended that you first take several small test doses to make sure you can tolerate it (e.g. 20mg 1st time, 100mg 2nd time, 500mg 3rd time; and wait 2wks between each test). A zinc/copper tablet each day (e.g. 25mg zinc, 2.5mg copper)is recommended by some alternative practitioners.

There are no interaction data with HIV drugs. This is the heart of this question. Should you take a treatment of uncertain benefit, after a single test of uncertain scientific validity to removed some trace substances that are likely to have been with you for many years without causing evident harm while placing an uncertain risk on your HIV drug exposures. I guess this is your call. I hope this helps you weigh up the risks and benefits. Regards Graeme Moyle


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