title: Adverse effects of D-penicillamine in rheumatoid arthritis.
abstract: Adverse effects to D-penicillamine were studied prospectively over 3 years in 259 patients with rheumatoid arthritis. Ninety-five percent had had gold therapy previously, yet 70% benefited from D-penicillamine therapy. Of the 275 courses given, 160 (58%) were complicated by at least one reaction, including rashes (44%), dysgeusia (20%), gastrointestinal upset (18%), stomatitis (10%), proteinuria (7%), thrombocytopenia (3%), and leukopenia (2%). Their occurrences peaked in the first 6 months of treatment, except for proteinuria and thrombocytopenia, which peaked in the second 6 months. Reactions were commoner at daily doses above 250 mg; mean daily doses for proteinuria, thrombocytopenia, and leukopenia were higher (approximately 600 mg/d) than for the others (approximately 500 mg/d). Of 114 discontinued courses, 73 (27%) were due to adverse reactions. The remaining reactions were controlled by altering dosages and symptomatic treatment. Only obliterative bronchiolitis (two cases) was irreversible; it resulted in the only death in our series, possibly attributable to penicillamine.
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D004334:Drug Administration Schedule; D005767:Gastrointestinal Diseases / Q000209:etiology*; D006402:Hematologic Diseases / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D010396:Penicillamine / Q000008:administration & dosage / Q000009:adverse effects*; D011446:Prospective Studies; D011507:Proteinuria / Q000097:blood / Q000209:etiology*; D012871:Skin Diseases / Q000209:etiology; D013280:Stomatitis / Q000209:etiology; D013649:Taste / Q000187:drug effects
chemical_list: D010396:Penicillamine