American College of Medical Toxicology and The American Academy of Clinical Toxicology
View all recommendations from this societyReleased September 26, 2013
Don’t recommend chelation except for documented metal intoxication which has been diagnosed using validated tests in appropriate biological samples.
Chelation does not improve objective outcomes in autism, cardiovascular disease or neurodegenerative conditions like Alzheimer’s disease. Edetate disodium is not FDA-approved for any condition. Even when used for appropriately diagnosed metal intoxication, chelating drugs may have significant side effects, including dehydration, hypocalcemia, kidney injury, liver enzyme elevations, hypotension, allergic reactions and essential mineral deficiencies. Inappropriate chelation, which may cost hundreds to thousands of dollars, risks these harms, as well as neurodevelopmental toxicity, teratogenicity and death.
These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.
How The List Was Created
The American College of Medical Toxicology’s (ACMT’s) Board of Directors established a Choosing Wisely® work group in 2013 to develop a list of items for the Choosing Wisely® campaign. Members of the work group were chosen to represent various practice settings within the field of medical toxicology, including ambulatory, acute and population-based practice. Work group members included the President of the College, the Chair of the Practice Committee, the Chair of the Positions and Guidelines committee and other academic leaders within the medical toxicology community. All work group members also represented the American Academy of Clinical Toxicology (AACT). The first list was released by the work group in 2013 and in 2014, the work group reconvened to develop a second list of items for the campaign. A second preliminary list was disseminated to all members of ACMT and AACT for review, commentary and potential additions. Additional feedback was solicited from leaders within the field of medical toxicology. The work group reviewed all responses, and narrowed the list to the final five items based on a review of scientific evidence, relevance to the specialty and greatest opportunity to improve care, reduce cost and reduce harm to patients.The final list was approved by the ACMT Board of Directors and the AACT Board of Trustees.
The ACMT and AACT disclosure and conflict of interest policies and be found at www.acmt.net and www.clintox.org respectively.
Sources
Nonstandard uses of chelation therapy. Med Lett Drugs Ther. 2010 Sep 20;52(1347):75–6.
Kosnett MJ. Chelation for heavy metals (arsenic, lead, and mercury): protective or perilous? Clin Pharmacol Ther. 2010 Sep;88(3):412–5.
Nissen SE. Concerns about reliability in the Trial to Assess Chelation Therapy (TACT). JAMA. 2013 Mar 27;309(12):1293–4.
Risher JF, Amler SN. Mercury exposure: evaluation and intervention the inappropriate use of chelating agents in the diagnosis and treatment of putative mercury poisoning. Neurotoxicology. 2005 Aug;26(4):691–9.
U.S. Food and Drug Administration. FDA warns marketers of unapproved ‘chelation’ drugs. FDA Consumer Health Information. 2010 October;1.
