Chelation therapy involves oral administration, intravenous infusion or intramuscular injection of drugs that increase excretion of heavy metals. The Medical Letter’s last article on this subject found no evidence that it was effective for treatment of cardiovascular disease. Since then, off-label use of chelation therapy has expanded to include treating children with autism and adults with Alzheimer’s disease, cancer and other chronic diseases.

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Tiopronin (Thiola - Mission), a thiol compound (mercaptopropionyl glycine) that solubilizes cystine by reacting with it to form a mixed disulfide, is now available in the USA for treatment of refractory cystinuria.