BAL Discontinued and DMPS on Back Order
British Anti-Lewisite (BAL) is the only chelator approved by Health Canada for the treatment of acute lead, mercury and arsenic poisonings. The Ontario Poison Centre (OPC) has become aware that British Anti-Lewisite (BAL) has now been discontinued and is no longer available in Canada.
Due to supply issues with BAL, since 2019 the Ontario Poison Centre has recommended that DMPS (2,3-dimercapto-1-propane sulfate) be stocked as an alternative chelator for acute treatment of lead, mercury and arsenic poisonings. OPC continues to recommend that individual hospital pharmacies or those with antidote sharing agreements procure DMPS from Health Canada Special Access Program (SAP) for “Future Use” for this indication.
OPC has recently been made aware that DMPS stocks are approaching expiry and that there is a supply backorder until August 2023. Ontario Poison Centre suggests that hospital pharmacies keep expired stock for use until new stock is available.
OPC recommends that every Emergency Department have a chelator in their antidote stocks for these indications. However, should chelator be unavailable, and a patient with acute heavy metal poisoning presents to hospital, DMPS or remaining BAL stocks might potentially be borrowed from surrounding hospitals at that time. As always, chelation for treatment of acute heavy metal poisonings should be started in consultation with the Ontario Poison Centre.