Chelation Therapy for Off-Label Uses

When Policy Topic is covered A number of indications for chelation therapy have received Food and Drug Administration (FDA) approval and for which chelation therapy is considered standard of care treatment. They include:  extreme conditions of metal toxicity;  treatment of chronic iron overload due to blood transfusions (transfusional hemosiderosis) and due to non-transfusion-dependent thalassemia (NTDT);  Wilson disease (hepatolenticular degeneration);  lead poisoning  control of ventricular arrhythmias or heart block associated with digitalis toxicity; and  emergency treatment of hypercalcemia. For the last 2 bullet points, most patients should be treated with other modalities. Digitalis toxicity is currently treated in most patients with Fab monoclonal antibodies. FDA removed the approval for NaEDTA as chelation therapy due to safety concerns and recommended that other chelators be used. This was the most common chelation agent used to treat digitalis toxicity and hypercalcemia.