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Penicillamine nephropathy and iron.

J A Harkness, D R Blake

    Lancet (London, England)
    |December 18, 1982
    PubMed
    Summary

    Oral iron supplements may interfere with penicillamine absorption, potentially leading to penicillamine-induced glomerulonephritis in rheumatoid arthritis patients. Stopping iron can increase penicillamine absorption, triggering this kidney complication.

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    Area of Science:

    • Nephrology
    • Rheumatology
    • Pharmacology

    Background:

    • Rheumatoid arthritis (RA) treatment often involves penicillamine.
    • Penicillamine can cause kidney damage, specifically glomerulonephritis.
    • Concurrent oral iron use is common in RA patients.

    Purpose of the Study:

    • To investigate the potential link between oral iron intake and the development of penicillamine-induced glomerulonephritis.
    • To understand how iron affects penicillamine absorption and subsequent toxicity.

    Main Methods:

    • Observational study of 16 rheumatoid arthritis patients with penicillamine glomerulonephritis.
    • Analysis of medication history, focusing on oral iron use.
    • Correlation of iron intake and discontinuation with the onset of glomerulonephritis.

    Main Results:

    • 7 of 16 patients with penicillamine glomerulonephritis were taking oral iron.
    • In 4 patients, glomerulonephritis developed after iron cessation, coinciding with increased penicillamine absorption.
    • Iron chelates with penicillamine in the gut, reducing its absorption.

    Conclusions:

    • Oral iron intake may reduce penicillamine absorption, potentially masking its toxicity until iron is stopped.
    • Discontinuation of oral iron can lead to a sudden increase in penicillamine absorption and the manifestation of glomerulonephritis.
    • Clinicians should be aware of this drug interaction when prescribing penicillamine to patients taking oral iron.

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