Aplastic anaemia penicillamine

Adverse effects are frequent. Patients may experience gastrointestinal upset, and dose-related impairment of taste is common. Thrombocytopenia is frequent but resolves when the drug is withdrawn unless it indicates the more serious aplastic anaemia which may also occur. Allergic reactions (rashes, fever) tend to occur during the early stages of treatment. Proteinuria, if it is heavy, is a reason for stopping penicillamine for it may herald the development of the nephrotic syndrome. 

Ramselaar AC, Dekker AW, Huber-Bruning O, Bijlsma JW. Acquired sideroblastic anaemia after aplastic anaemia caused by D-penicillamine therapy for rheumatoid arthritis. Ann Rheum Dis 1987 46(2) 156-8. 

Fishel B, Tishler M, Caspi D, Yaron M. Fatal aplastic anaemia and liver toxicity caused by D-penicillamine treatment of rheumatoid arthritis. Ann Rheum Dis 1989 48(7) 609-10. 

A case is reported of red cell aplasia in a patient with Wilson s disease, who had been treated for 14 years with up to 2 g penicillamine daily (16 ). The erythropoiesis rapidly recovered after discontinuation of penicillamine. The serum copper concentration was 5/ug/dl (normal 80-150 jug/dl). Another case report concerns a patient who died from aplastic anaemia, which was thought to be drug-induced (17, 21 ). This patient had been treated for rheumatoid arthritis... 

Scheinberg, 1. H. (1976) Fatal aplastic anaemia and D-penicillamine. Lancet, April 24, 910. 

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