British anti-Lewisite
By Domingo Tabangcura, Jr. and G. Patrick Daubert, MD


Adverse Effects

The major drawbacks of BAL include:
  1. Low therapeutic index (small margin of safety)
  2. Tendency to redistribute arsenic to brain and testes, for example
  3. Need for (painful) intramuscular injection
  4. Unpleasant odor (rotten eggs!)
Common adverse effects include fever, conjunctivitis (eye inflammation), lacrimation (tearing), constricted feeling (chest, limbs, jaw, abdomen), headache, paresthesias (tingling sensation), tremor, nausea, and pain at the injection site.[13] More serious complications include infections (abscesses) at the injection site, liver damage, elevated blood pressure and heart rate, and hemolysis (destruction of red blood cells) in patients with glucose-6-phophate deficiency (G6PD).[13, 14] BAL should be avoided in pregnancy if possible (Class C).

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