88: Antimony

HISTORY AND EPIDEMIOLOGY

Antimony (Sb) and its compounds are among the oldest known remedies in the practice of medicine.^102,154 Because of a strong chemical similarity to arsenic, the features of antimony poisoning closely resemble arsenic poisoning (Chap. 89). Antimony poisoning also shares features common with other metal poisonings in the chapters that follow. Although relatively uncommon, antimony toxicity still occurs, usually as a complication of the treatment of visceral leishmanias.⁹² Acute overdose represents an even more rare, but potentially lethal event, often as a result of a nonconventional alcohol aversion treatment.^99,139

Objects discovered during exploration of ancient Mesopotamian life (third and fourth millennium b.c.) suggested that both the Sumerians and the Chaldeans were able to produce pure antimony.^102,154 The reference to eye paint in the Old Testament suggested the use of antimony.¹⁰² For several thousand years, Asian and Middle Eastern countries used antimony sulfide in the production of cosmetics, including rouge and black paint for eyebrows, also known as kohl or surma.^97,103 Because of the scarcity of antimony sulfide, lead replaced antimony as a main component in more modern cosmetic preparations.

One of the first monographs on metals, written in the 16th century, included a description of antimony.¹⁴⁶ The medicinal use of antimony for the treatment of syphilis, whooping cough, and gout dates to the medieval period. Paracelsus was credited with establishing antimony compounds as therapeutic agents and increasing their popularity. In spite of being aware of its toxic potential, many of the disciples of Paracelsus enthusiastically continued the use of antimony.¹⁰² Various antimony compounds were also used as topical preparations for the treatment of herpes, leprosy, mania, and epilepsy.¹⁵⁴ Orally administered tartar emetic (antimony potassium tartrate) was used for treatment of fever, pneumonia, inflammatory conditions, and as a decongestant, emetic, and sedative, but it was abandoned because of its significant toxicity.^22,47,66,81 The use of antimony as a homicidal agent¹⁴⁰ continued well into the 20th century (Chap. 1).

The current medical use of antimony is limited to the treatments of leishmaniasis and schistosomiasis, and to sporadic use as aversive therapy for substance abuse.^99,139 Pentavalent compounds are used because they are better tolerated. In the endemic regions of the world, generic pentavalent antimonials remain the mainstay of therapy because of their efficacy and low cost; however, the growing incidence of resistance may reduce future use.¹⁰⁷

Some contemporary homeopathic⁶⁰ and anthroposophical¹³³ practices still recommend use of antimonial compounds as home remedies; however, these practices are rare.^102,154 In spite of its anticancer effects in vitro⁴⁷ and remarkable therapeutic efficacy in patients with acute promyelocytic leukemia,¹²⁹ there is no current accepted oncologic use of antimony. When compared to suramin, a well-known ...