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Treatment of Chlordecone (Kepone) Toxicity with Cholestyramine — Results of a Controlled Clinical Trial

List of authors.
  • William J. Cohn, M.D.,
  • James J. Boylan, M.D.,
  • Robert V. Blanke, Ph.D.,
  • Marc W. Fariss, B.S.,
  • John R. Howell, M.S.,
  • and Philip S. Guzelian, M.D.

Abstract

Industrial workers exposed to the organochlorine pesticide, chlordecone (Kepone), had signs of toxicity in several organs. The extent of toxicity was proportional to the levels of this chemical in the tissues. In 22 patients, chlordecone was eliminated slowly from blood (half time of 165±27 days — mean ± S.E.M.) and fat (half time of 125 days, with a range of 97 to 177), chiefly in the stool. Output of chlordecone in bile was 10 to 20 times greater than in stool, suggesting that chlordecone is reabsorbed in the intestine. Cholestyramine, an anion-exchange resin that binds chlordecone, increased its fecal excretion by seven times. In a five-month trial, cholestyramine significantly accelerated elimination of chlordecone from blood, with a half life of 80±4 days (S.E.M.) (P<0.005) and fat (half life of 64 days, with a range of 52 to 85) (P<0.05). Cholestyramine offers a practical means for detoxification of persons exposed to chlordecone and possibly to other lipophilic toxins. (N Engl J Med 298:243–248, 1978)

Funding and Disclosures

Supported by a grant (1–R01-ES 01519) from the National Institute of Environmental Health Sciences, by a grant from Allied Chemical Corporation, by a contract (N01-ES-6–2117) with the National Institute of Environmental Health Sciences and by the Clinical Research Center (Dr. Guzelian is the recipient of a clinical investigator award in gastroenterology from the National Institutes of Health [5–K08-AM-00128], and Dr. Boylan the recipient of a training grant [5–T32-AM-0715002] from the National Institutes of Health).

Presented in part at a meeting of the American Association for the Study of Liver Diseases, Chicago, IL, November 5, 1976.

* 1,1a,3,3a,4,5,5,5a,5b,6-decachloro-octahydro-1,3,4-metheno-2H-cyclobuta[cd]pentalen-2-one: _i16image

We are indebted to Drs. John Taylor and William Blackard and the staff of the Clinical Research Center for assistance in conducting these clinical studies, to Drs. Charles Schwartz and Z. Reno Vlahcevic for supplying cholecystokinin and analyses of stigmasterol, to Dr. Lorne Garrettson for helpful suggestions and to Dr. Gabriel Makhlouf for a review of the manuscript.

Author Affiliations

From the departments of Medicine and Pathology, Medical College of Virginia (address reprint requests to Dr. Guzelian at Box 217, MCV Station, Medical College of Virginia, Richmond, VA 23298).

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