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[D-penicillamine--side effects, pathogenesis and decreasing the risks].

K Grasedyck1

  • 1Med. Kernklinik und Poliklinik der Universität Hamburg.

Zeitschrift Fur Rheumatologie
|January 1, 1988
PubMed
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D-penicillamine (DPA) causes numerous side effects, including skin fragility, blood disorders, and autoimmune reactions. Due to its significant risks, DPA requires clear indications and regular patient monitoring.

Area of Science:

  • Pharmacology
  • Dermatology
  • Immunology

Context:

  • D-penicillamine (DPA) is a chelating agent used in treating Wilson's disease, cystinuria, and rheumatoid arthritis.
  • Its therapeutic benefits are often offset by a wide range of adverse effects.
  • Understanding these side effects is crucial for patient safety and treatment management.

Purpose:

  • To comprehensively review the spectrum of side effects associated with D-penicillamine (DPA) therapy.
  • To identify risk factors and contraindications for DPA use.
  • To emphasize the necessity of careful patient selection and monitoring during DPA treatment.

Summary:

  • DPA inhibits collagen and elastin crosslinking, leading to skin issues like cutis laxa and impaired wound healing.

Related Experiment Videos

  • Common toxic effects include gastrointestinal disturbances, taste alterations, and hematologic abnormalities (thrombo- and leukocytopenia).
  • Severe adverse events encompass autoimmune phenomena (pemphigus, lupus erythematosus, myasthenia gravis) and hypersensitivity reactions, affecting 1-10% of patients.

    • Impact:

    • DPA therapy is associated with a high incidence of side effects (30-60%) and a substantial withdrawal rate (20-30%).
    • Genetic predisposition (HLA-B8, -DR3) and impaired metabolic function are identified risk factors.
    • Contraindications include pregnancy and significant bone marrow, liver, or renal dysfunction, underscoring the need for judicious use and regular surveillance.