Chelation Therapy: Uses, Side Effects and Who Needs It

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Chelation therapy is one of medicine's antidotes for metal poisoning. A chelating drug travels through your blood, latches onto a toxic metal such as lead, mercury, arsenic or iron, and holds it in a tight bundle your body can carry out in the urine and bile.211 Modern chelation began in wartime Britain, where scientists developed dimercaprol as an antidote to lewisite, an arsenic-based chemical weapon, and two related drugs, DMPS and succimer, followed in the late 1950s.12

When a metal load becomes poisoning, chelation is a powerful prescription tool, and for acute arsenic poisoning or mercury poisoning, the sooner it starts, the better it works.12 That makes it a different thing from a heavy metal detox, the daily food, water, fiber and binder steps that help your body clear the smaller amounts of metals we all meet in water, food and older homes.

Your body was designed to clear what it doesn't need. Heavy metals are one of the hidden loads that add oxidative stress and inflammation your mitochondria have to fight every day, and for that everyday load, I'd rather support your body than force it.1314

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What is chelation therapy?

Chelating agents bind lead and other metals in your soft tissues and raise the amount that leaves in your urine and bile, which lowers the total amount in your body.2 As of 2013, 11 FDA-approved chelating drugs were available, and every one required a prescription.15

A 2013 review of chelation in American health care cited a National Center for Health Statistics estimate that more than 100,000 Americans receive chelation each year, far fewer than 1% of them under the care of medical toxicologists, the physicians who specialize in poisoning.15

How does chelation therapy work?

A chelating drug grabs a metal where it sits in your blood and tissues, and your kidneys carry the bound metal out. Here's the path for lead:

Two limits shape how it's used. Neither calcium EDTA nor succimer crosses into the brain to any major extent, and succimer's label rules it out for lead encephalopathy, the brain injury of severe lead poisoning.1116 A chelator also has to match the metal, and the metal has to be what's causing the harm; in long-term cadmium poisoning, for example, chelation isn't supported.17

Which drugs are used for chelation therapy?

Chelating agents are matched to the metal and the person. These are the main ones a prescriber chooses from:

Deferasirox, a newer chelator taken by mouth, is another option for iron overload from transfusions. A Cochrane review of 16 randomized trials with 1,807 people with thalassemia found that it leads to net iron excretion (in its two placebo-controlled studies), could match deferoxamine on iron markers depending on the doses compared (nine trials, 1,251 people), and left people who had switched from deferoxamine more than twice as likely to be satisfied.18 DMPS (unithiol), a relative of succimer and dimercaprol, is approved in Europe but not by the FDA.1219

Who needs chelation therapy?

For lead, the decision rests on the blood lead number and the source. CDC's guidance brings in chelation for children starting at 45 µg/dL, managed with a medical toxicologist or a pediatrician experienced in it.7 For adults, a panel of lead specialists advises removing a worker from exposure when a single blood lead tops 30 µg/dL, or two readings four weeks apart reach 20, and gives chelation a supporting role for highly exposed adults with symptoms; they don't recommend it for adults with low levels and no symptoms.20 When lead poisoning is moderate or severe, a review of the studies comparing calcium EDTA and succimer found that both relieve its symptoms rapidly.11

Succimer's label tells prescribers to find and remove a child's source of lead before treatment begins, and the calcium EDTA label says chelation should not replace the steps that end or reduce further exposure.163 In young monkeys exposed to lead, succimer cleared lead only slightly better than ending the exposure alone.22

For arsenic and mercury, animal studies show chelation works best when it starts within minutes to a few hours of acute poisoning, so treatment begins as soon as possible. After long-term exposure, it can speed these metals out of the body, though its effect on illness and survival hasn't been established.12 Our guides to mercury poisoning and arsenic poisoning cover the signs of each.

Deferoxamine treats acute iron poisoning and the iron overload that builds up from repeated blood transfusions.5 In Wilson disease, an inherited condition in which copper builds up in the liver and brain, copper chelators and zinc are the standard treatments, and they work best when the diagnosis is made in time.6

What did chelation do for children with moderate lead levels?

Researchers tested this in 780 children aged 12 to 33 months with blood lead levels of 20 to 44 µg/dL, all living in older inner-city housing. The children got up to three 26-day courses of succimer or a placebo, and neither the families nor the researchers knew which children got the drug. Succimer lowered blood lead by 4.5 µg/dL more than placebo over the first 6 months. Three years later, IQ, behavior and neuropsychological scores showed small differences in both directions, none statistically significant, and when 647 of the children were tested again at age 7, chelation still showed no benefit for thinking, behavior or movement.2324

Every child's home had its lead hazards cleaned up before treatment began.24 The researchers concluded that chelation isn't indicated for children at these levels, and finding and ending the lead exposure is the most important treatment.2321

How is heavy metal poisoning confirmed?

Test before you treat. A heavy metal panel is one of the tests I suggest, and the first lab on my detox list is a comprehensive toxicity panel that includes heavy metals, with a target of minimal or undetectable levels.2728 If you've had a known exposure, ask your doctor for a blood or urine test for that metal before anything else.725

Can you do chelation therapy at home?

Products sold for home chelation come as nasal sprays, suppositories, liquid drops and clay baths, some of them labeled as dietary supplements, and some companies pair them with urine screening tests the FDA hasn't cleared, which may give false or misleading results.1 The FDA's concern is twofold: people may delay proven care for serious conditions such as heart disease while relying on these products, and chelation can cause serious side effects such as dehydration, kidney failure and death, whether the goal is treatment or a general detox.1

The agency has acted on that concern more than once. In October 2010, it sent warning letters to eight companies selling over-the-counter chelation products for conditions including heart disease, macular degeneration and Parkinson's disease.32 In June 2014, after a company recalled an over-the-counter product listing DMSA as its active ingredient following several adverse event reports, the FDA advised consumers to avoid over-the-counter chelation products.33

How can you lower heavy metals without chelation?

For the everyday metals we all meet in tap water and food, the goal is to lower what comes in and support the organs that already clear them. Your liver, kidneys, gut, skin and lymphatic system do this work every day, and your job is to support them, not force them.14 In my practice, I took heavy metal detox gently and over a longer period, almost as a lifestyle.34

More aggressive is not better. Think about how amazing God made your body, and support it naturally.14 The psalmist put it this way: "I will praise thee; for I am fearfully and wonderfully made: marvellous are thy works; and that my soul knoweth right well" (Psalm 139:14).

Our heavy metal detox guide lays out the full plan, from filtered water and low-mercury fish to glutathione support and gentle binders.28 The binders I recommend, such as spirulina, chlorella and modified citrus pectin, act in your gut: they trap toxins so they leave in your stool instead of being reabsorbed through the gut wall.3528

One food on that plan has been tested head to head against a chelating drug. In a randomized trial of 117 car-battery workers with chronic lead poisoning, 4 weeks of garlic (1,200 micrograms of allicin three times a day) gave similar results to the chelating drug d-penicillamine (250 mg three times a day). Blood lead fell from 426.32 to 347.34 µg/L (about 42.6 to 34.7 µg/dL) on garlic and from 417.47 to 315.76 µg/L (about 41.7 to 31.6 µg/dL) on the drug, a gap between groups too small to be sure of. Irritability, headaches, weak reflexes and systolic blood pressure improved on garlic but not on the drug, and side effects were more common on the drug; there was no placebo group.36

If your doctor prescribes chelation for confirmed poisoning, the food, water, fiber and sweat steps continue alongside it.

Does EDTA chelation therapy work for heart disease?

Disodium EDTA infusions have been used for more than 50 years to treat atherosclerosis, the plaque buildup that narrows arteries, without proof that they worked, and that's what two placebo-controlled trials set out to test.9 In 1999, the Federal Trade Commission ordered a chelation practitioners' association to stop claiming that EDTA chelation treats atherosclerosis without competent and reliable scientific evidence, an order that ran until 2019.37

TACT enrolled 1,708 adults aged 50 or older who'd had a heart attack at least 6 weeks earlier, at 134 sites in the U.S. and Canada. They received 40 infusions of a disodium EDTA solution that also contained vitamin C, B vitamins, electrolytes, the numbing agent procaine and the blood thinner heparin, or a placebo, and neither the people nor the researchers knew who got what. Over a median of 55 months, 26% of the chelation group had a death, heart attack, stroke, procedure to reopen an artery or hospital stay for angina, against 30% on placebo, a statistically significant result (P = .035, against the trial's preset bar of .036).9 Many of those events were artery-opening procedures, deaths were about the same (10% vs. 11%), and 17% of participants withdrew consent along the way, more of them on placebo.9

The clearest signal came from the 633 participants with diabetes, a group the researchers had planned in advance to examine. Among them, 25% on chelation had one of those heart events or procedures, against 38% on placebo, and the difference held up after adjusting for the many subgroups tested, while the 1,075 without diabetes saw no benefit.38 The researchers called for a trial to replicate the finding before any routine use.38

TACT2 was that trial. It randomly assigned 1,000 adults aged 50 or older with diabetes and a heart attack at least 6 weeks earlier, at 88 sites, to 40 weekly infusions of an EDTA-based solution or a placebo, again with neither the people nor the researchers knowing who got what, and analyzed the 959 who received at least one infusion. Over a median of 48 months, 35.6% of the chelation group and 35.7% of the placebo group had one of the trial's main heart events or procedures. Heart-related death, heart attack or stroke occurred in 18.4% and 19.7%, and deaths from any cause in 17.4% and 17.6%.10

The infusions did lower blood lead. On chelation, median blood lead fell by more than half, from 9.03 to 3.46 µg/L by the 40th infusion, while the placebo group went from 9.3 to 8.7.10 In the µg/dL units blood lead tests report, that's about 0.9 falling to 0.35. Even so, the researchers concluded that EDTA chelation didn't reduce heart events in these patients.10

A smaller placebo-controlled trial, PATCH, pointed the same way. It gave 84 adults with coronary artery disease and chest pain on exertion EDTA infusions or a placebo for about 6 months, with both groups taking multivitamins and neither the people nor the researchers knowing who got what. The time they could exercise on a treadmill before signs of reduced blood flow rose by about a minute in both groups (63 seconds on chelation, 54 on placebo), a difference too small to be sure of.39

If your heart is the reason you're here, start with your numbers: ApoB and the other heart disease tests worth asking for show where you stand, and our guide on how to improve heart health covers the daily steps that move them.

Chelation therapy side effects and risks

These are the risks to know, and who should be most careful:

• Kidney injury. Calcium EDTA carries a boxed warning that it can cause toxic effects that can be fatal, and it can damage the kidneys the way lead itself does. The harm rises with the dose, so urine flow is watched throughout treatment, and it isn't given when urine output stops or to people with active kidney disease or hepatitis.3

• Dangerously low calcium. From 2003 to 2005, three people died of cardiac arrest from low calcium during chelation: a 2-year-old girl being treated in a hospital for lead poisoning who was given edetate disodium by mistake instead of calcium EDTA, a 5-year-old boy given edetate disodium in a physician's office, and a 53-year-old woman receiving IV EDTA at a clinic.2 In 2008, the FDA withdrew approval of edetate disodium, after reports that children and adults had died when it was given by mistake instead of calcium EDTA or used for unapproved purposes.40 Even in TACT, the monitored placebo-controlled heart trial, low calcium before an infusion turned up in 6.2% of people on chelation, against 3.5% on placebo.9

• Lost minerals. Calcium EDTA and succimer both deplete zinc and copper, and zinc deficiency is a listed side effect of calcium EDTA, which pulls out more zinc than succimer does.113 Our guides to zinc deficiency and electrolyte imbalance cover the signs.

• Stomach upset and skin reactions. Nausea, vomiting, diarrhea, appetite loss and a metallic taste affected 12% of children taking succimer in its studies, and its label warns of allergic and skin reactions. The label also calls for blood counts and liver enzyme checks during treatment, because succimer can lower white blood cells and raise liver enzymes.16

• The wrong drug for the metal. Dimercaprol is never used for iron, cadmium or selenium poisoning, because the bound complexes are more toxic than the metal alone, especially to the kidneys. It's also made with peanut oil, which matters for anyone with a peanut allergy.4

• Pregnancy. Succimer's label says it may cause fetal harm, and calcium EDTA should be used in pregnancy only if clearly needed.163

Under close monitoring in TACT2, the placebo-controlled heart trial, serious adverse events were about as common on chelation as on placebo (16.8% vs. 16.6%), with no unexpected serious events.10

If someone swallows something poisonous or has sudden, severe symptoms, call Poison Control at 1-800-222-1222 or 911.7

The bottom line

Chelation therapy: frequently asked questions

References

1. U.S. Food and Drug Administration. Questions and Answers on Unapproved Chelation Products. Content current as of February 2, 2016.
2. Centers for Disease Control and Prevention (CDC). Deaths associated with hypocalcemia from chelation therapy--Texas, Pennsylvania, and Oregon, 2003-2005. MMWR Morb Mortal Wkly Rep. 2006;55(8):204-7.
3. Rising Pharma Holdings, Inc. Edetate calcium disodium injection: prescribing information. Revised January 2025. DailyMed (boxed warning; indications; contraindicated during anuria and in active renal disease or hepatitis; dose-dependent nephrotoxicity; poorly absorbed from the gastrointestinal tract; zinc excretion and zinc deficiency; interferes with zinc insulin preparations; pregnancy).
4. Taylor Pharmaceuticals. BAL in Oil (dimercaprol injection USP): prescribing information. Rev. October 2006. DailyMed (arsenic, gold and mercury poisoning; acute lead poisoning used with edetate calcium disodium; not in iron, cadmium or selenium poisoning; medicinal iron not given during therapy; formulated with peanut oil; deep intramuscular injection only).
5. Hospira, Inc. Deferoxamine mesylate for injection: prescribing information. Revised March 2026. DailyMed (acute iron intoxication; transfusional iron overload; not for primary hemochromatosis; vitamin C delayed one month, at most 200 mg daily in adults, cardiac function monitored).
6. Alkhouri N, Gonzalez-Peralta RP, Medici V. Wilson disease: a summary of the updated AASLD Practice Guidance. Hepatol Commun. 2023;7(6). doi:10.1097/HC9.0000000000000150
7. Centers for Disease Control and Prevention. Recommended Actions Based on Blood Lead Level. Childhood Lead Poisoning Prevention. Last reviewed August 21, 2025.
8. American College of Medical Toxicology. American College of Medical Toxicology position statement on post-chelator challenge urinary metal testing. J Med Toxicol. 2010;6(1):74-5. doi:10.1007/s13181-010-0039-0
9. Lamas GA, Goertz C, Boineau R, Mark DB, Rozema T, Nahin RL, et al. Effect of disodium EDTA chelation regimen on cardiovascular events in patients with previous myocardial infarction: the TACT randomized trial. JAMA. 2013;309(12):1241-50. doi:10.1001/jama.2013.2107
10. Lamas GA, Anstrom KJ, Navas-Acien A, Boineau R, Nemeth H, Huang Z, et al. Edetate Disodium-Based Chelation for Patients With a Previous Myocardial Infarction and Diabetes: TACT2 Randomized Clinical Trial. JAMA. 2024;332(10):794-803. doi:10.1001/jama.2024.11463
11. Bradberry S, Vale A. A comparison of sodium calcium edetate (edetate calcium disodium) and succimer (DMSA) in the treatment of inorganic lead poisoning. Clin Toxicol (Phila). 2009;47(9):841-58. doi:10.3109/15563650903321064
12. Kosnett MJ. The role of chelation in the treatment of arsenic and mercury poisoning. J Med Toxicol. 2013;9(4):347-54. doi:10.1007/s13181-013-0344-5
13. Axe J. Heal Your Cells: The Mitochondrial Longevity Protocol. DrAxe.com. 2026 (Phase 1, Clear: "Lower the toxin load — filtered water, glass instead of plastic, a clean-air bedroom, no smoking"; "Toxins & infections… heavy metals… add oxidative stress and inflammation the mitochondria must fight every day," p. 11).
14. Axe J. Top 10 Worst Health Trends (That Everyone Thinks Are Healthy). The Dr. Josh Axe Show. 2026 (solo episode; "Your body heals itself. What we're here to do is support your body" at 36:05; "Think about how amazing God made your body and just naturally supporting it" at 38:45; "Your liver, your kidney, your gut, your skin, your lymphatic system, your colon, they all need support. Your job is to support them. Not to force them" at 39:40; on YouTube: https://www.youtube.com/watch?v=gDmz6u5Vt7Q&t=2165s).
15. Wax PM. Current use of chelation in American health care. J Med Toxicol. 2013;9(4):303-7. doi:10.1007/s13181-013-0347-2
16. Recordati Rare Diseases, Inc. CHEMET (succimer) capsules, for oral use: prescribing information. Revised September 2024. DailyMed (indication above 45 mcg/dL in children 1 year and older; limitations of use; source removal before treatment; rebound from bone stores; 19-day course and at least two weeks between courses; digestive adverse reactions 12%; hypersensitivity and dermatologic reactions; neutropenia and hepatic transaminase monitoring; not combined with other chelation therapy; may cause fetal harm).
17. Smith SW. The role of chelation in the treatment of other metal poisonings. J Med Toxicol. 2013;9(4):355-69. doi:10.1007/s13181-013-0343-6
18. Bollig C, Schell LK, Rücker G, Allert R, Motschall E, Niemeyer CM, et al. Deferasirox for managing iron overload in people with thalassaemia. Cochrane Database Syst Rev. 2017;8(8):CD007476. doi:10.1002/14651858.CD007476.pub3
19. Banner Health. Transdermal Absorption of DMPS and Its Effect on Urinary Mercury Excretion. ClinicalTrials.gov identifier NCT01059474 (study summary: "While not an FDA-approved drug in the US, it is easily obtained and administered by alternative health practitioners").
20. Kosnett MJ, Wedeen RP, Rothenberg SJ, Hipkins KL, Materna BL, Schwartz BS, et al. Recommendations for medical management of adult lead exposure. Environ Health Perspect. 2007;115(3):463-71. doi:10.1289/ehp.9784
21. McKay CA. Role of chelation in the treatment of lead poisoning: discussion of the Treatment of Lead-Exposed Children Trial (TLC). J Med Toxicol. 2013;9(4):339-43. doi:10.1007/s13181-013-0341-8
22. Smith D, Strupp BJ. The scientific basis for chelation: animal studies and lead chelation. J Med Toxicol. 2013;9(4):326-38. doi:10.1007/s13181-013-0339-2
23. Rogan WJ, Dietrich KN, Ware JH, Dockery DW, Salganik M, Radcliffe J, et al. The effect of chelation therapy with succimer on neuropsychological development in children exposed to lead. N Engl J Med. 2001;344(19):1421-6. doi:10.1056/NEJM200105103441902
24. Dietrich KN, Ware JH, Salganik M, Radcliffe J, Rogan WJ, Rhoads GG, et al. Effect of chelation therapy on the neuropsychological and behavioral development of lead-exposed children after school entry. Pediatrics. 2004;114(1):19-26. doi:10.1542/peds.114.1.19
25. Ruha AM. Recommendations for provoked challenge urine testing. J Med Toxicol. 2013;9(4):318-25. doi:10.1007/s13181-013-0350-7
26. American College of Medical Toxicology. ACMT Recommends Against Use of Post-Chelator Challenge Urinary Metal Testing. J Med Toxicol. 2017;13(4):352-354. doi:10.1007/s13181-017-0624-6
27. Axe J. Cellular Toxicity: The Root Cause of Aging, Inflammation & Chronic Disease. The Dr. Josh Axe Show. 2026 (solo episode; "do some testing. You can do a heavy metal panel" at 36:58; on YouTube: https://www.youtube.com/watch?v=yNwVs_gAjBc&t=2218s).
28. Axe J, Cole W. Heal Your Cells. Avery; 2026. ISBN 9798217181353 (detox plan, Step 1 "Reduce toxic input", Step 2 "Support daily elimination" and Step 3 "Open and reinforce detox pathways" with glutathione support and binders; "Precision Healing Protocols," detox lab list, item 1 "Comprehensive toxicity panel (heavy metals, mycotoxins, environmental toxins)," optimal target "Minimal or undetectable levels," p. 342; liver supplement list, item 6 "Spirulina/chlorella": binds heavy metals, supports detox, 3–5 g/day, p. 344).
29. Centers for Disease Control and Prevention. CDC Updates Blood Lead Reference Value. Childhood Lead Poisoning Prevention. 2021 (3.5 µg/dL, the 97.5th percentile for U.S. children aged 1–5; not a health-based standard or a toxicity threshold).
30. Weiss ST, Campleman S, Wax P, McGill W, Brent J, Toxicology Investigators Consortium. Failure of chelator-provoked urine testing results to predict heavy metal toxicity in a prospective cohort of patients referred for medical toxicology evaluation. Clin Toxicol (Phila). 2022;60(2):191-196. doi:10.1080/15563650.2021.1941626
31. Axe J. The 25 Root-Cause Bloodwork Markers That Matter Most. DrAxe.com protocol. 2026 (marker 14, RBC zinc: functional range 12–14 mg/L; conventional lab range 9–14 mg/L).
32. HealthDay. FDA Issues Warnings About Unapproved "Chelation" Drugs. October 15, 2010 (FDA warning letters to eight companies, October 14, 2010).
33. U.S. Food and Drug Administration. FDA warns consumers about potential health risks from using Thorne Research's Captomer products. June 12, 2014; content current as of November 30, 2015.
34. Axe J. 5 Pillars of Longevity You Need to Know | Dr. Halland. The Dr. Josh Axe Show. 2024 (Dr. Axe at 35:06: when he practiced full-time functional medicine with heavy metal testing, "for most people you want to detox slower rather than faster"; at 36:00: someone "doing coffee enemas every day and… this heavy chelation therapy, and they felt awful… that's probably not the best way to go about it… being that aggressive"; on YouTube: https://www.youtube.com/watch?v=COcCYokA91Y&t=2106s).
35. Axe J. Heal From Parasites Protocol: The 30-Day System. DrAxe.com. 2026 (Phase 4, Bind & eliminate, p. 19: toxins and heavy metals that aren't bound "get reabsorbed through your gut wall and recirculate"; "Take binders 2 hours away from food, herbs, and supplements — binders trap everything indiscriminately"; chlorella "binds heavy metals as well as toxins"; modified citrus pectin as a binder).
36. Kianoush S, Balali-Mood M, Mousavi SR, Moradi V, Sadeghi M, Dadpour B, et al. Comparison of therapeutic effects of garlic and d-Penicillamine in patients with chronic occupational lead poisoning. Basic Clin Pharmacol Toxicol. 2012;110(5):476-81. doi:10.1111/j.1742-7843.2011.00841.x
37. Federal Trade Commission. In the Matter of American College for Advancement in Medicine. Decision and Order, Docket No. C-3882. June 22, 1999.
38. Escolar E, Lamas GA, Mark DB, Boineau R, Goertz C, Rosenberg Y, et al. The effect of an EDTA-based chelation regimen on patients with diabetes mellitus and prior myocardial infarction in the Trial to Assess Chelation Therapy (TACT). Circ Cardiovasc Qual Outcomes. 2014;7(1):15-24. doi:10.1161/CIRCOUTCOMES.113.000663
39. Knudtson ML, Wyse DG, Galbraith PD, Brant R, Hildebrand K, Paterson D, et al. Chelation therapy for ischemic heart disease: a randomized controlled trial. JAMA. 2002;287(4):481-6. doi:10.1001/jama.287.4.481
40. U.S. Food and Drug Administration. Hospira, Inc., et al.; Withdrawal of Approval of One New Drug Application and Two Abbreviated New Drug Applications (edetate disodium injection). Federal Register. 2008;73(114):33440-33441. Effective June 12, 2008.

Dr. Josh Axe, DC, DNM, CNS

Doctor of Natural Medicine · Founder, DrAxe.com

Dr. Axe is a certified doctor of natural medicine, clinical nutritionist, and multiple New York Times bestselling author. He has spent 20+ years in clinical practice helping people heal at the root cause and founded one of the most-visited natural-health platforms in the world.

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