Adverse Effects of D-Penicillamine in Rheumatoid Arthritis

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Abstract
Adverse effects to D-penicillamine were studied prospectively over 3 yr in 259 patients with rheumatoid arthritis. Ninety-five percent had had Au therapy previously, yet 70% benefited from D-penicillamine therapy. Of the 275 courses given, 160 (58%) were complicated by at least 1 reaction, including rashes (44%), dysgeusia (20%), gastrointestinal upset (18%), stomatitis (10%), proteinuria (7%), thrombocytopenia (3%), and leukopenia (2%). Their occurrences peaked in the 1st 6 mo. of treatment, except for proteinuria and thrombocytopenia, which peaked in the 2nd 6 mo. Reactions were more common at daily doses above 250 mg; mean daily doses for proteinuria, thrombocytopenia, and leukopenia were higher (.apprx. 600 mg/d) than for the others (.apprx. 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 (2 cases) was irreversible; it resulted in the only death in the series, possibly attributable to penicillamine.

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