Chapter 85: Antimony

INTRODUCTION

HISTORY AND EPIDEMIOLOGY

Antimony (Sb) and its compounds are among the oldest known remedies in the practice of medicine.^115,169 Because of a strong chemical similarity to arsenic, the features of antimony poisoning closely resemble arsenic poisoning (Chap. 86). Antimony poisoning also shares features common with other metal poisonings, described in the chapters that follow. Although relatively uncommon, antimony toxicity occurs, usually as a complication of the treatment of visceral leishmaniasis.¹⁰¹ Acute overdose represents an even rarer, but potentially lethal event, most often recently as a result of a unconventional alcohol aversion treatment.^109,154

Objects discovered during exploration of ancient Mesopotamian life (third and fourth millennium B.C.) suggest that both the Sumerians and the Chaldeans were able to produce pure antimony.^115,169 The reference to eye paint in the Old Testament suggested the use of antimony.¹¹⁵ 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.^106,114 Because of the scarcity of antimony sulfide, lead replaced antimony as a main component in antiquated cosmetic preparations.

One of the first monographs on metals, written in the 16th century, included a description of antimony.¹⁶⁰ The medicinal use of antimony for the treatment of syphilis, whooping cough, and gout dates to the medieval period. Paracelsus was credited with establishing the therapeutic efficacy of antimony compounds 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.¹¹⁵ Various antimony compounds were also used as topical preparations for the treatment of herpes, leprosy, mania, and epilepsy.¹⁶⁹ 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.^26,53,76,88 The use of antimony as a homicidal agent¹⁵⁵ 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.^109,154 Pentavalent compounds are used as antiparasitics 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. The growing incidence of resistance is affecting their use,¹¹⁹ forcing a shift toward the use of novel cost-effective delivery systems for antimonials and second-line agents as amphotericin B, miltefosine, and paromomycin (aminosidine).⁷⁵

Some contemporary homeopathic⁶⁷ and anthroposophical¹⁴⁸ practices recommend the use of antimonial compounds as home remedies in rare cases.^115,169 In spite of its ...