HOWARD B. STEIN, M.D.; A. CAROLINE PATTERSON, M.B.; ROBERT C. OFFER, M.D.; CHRISTOPHER J. ATKINS, M.B.; ALVENA TEUFEL, R.N.; HAROLD S. ROBINSON, M.D.
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 (∼ 600 mg/d) than for the others (∼ 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.
STEIN HB, PATTERSON AC, OFFER RC, ATKINS CJ, TEUFEL A, ROBINSON HS. Adverse Effects of D-Penicillamine in Rheumatoid Arthritis. Ann Intern Med. ;92:24–29. doi: 10.7326/0003-4819-92-1-24
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Published: Ann Intern Med. 1980;92(1):24-29.
Rheumatoid Arthritis, Rheumatology.
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