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.
HOWARD B. STEIN, A. CAROLINE PATTERSON, ROBERT C. OFFER, CHRISTOPHER J. ATKINS, ALVENA TEUFEL, HAROLD S. ROBINSON. Adverse Effects of D-Penicillamine in Rheumatoid Arthritis. Ann Intern Med. 1980;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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