Skin toxicity penicillamine

The adverse reactions seen with penicillamine include pruritus, rash, anorexia, nausea, vomiting, epigastric pain, bone marrow depression, proteinuria, hematuria, increased skin friability, and tinnitus. Penicillamine is capable of causing severe toxic reactions. 

Penicillamine. The primary healHi care provider will explain Hie treatment regimen and adverse reacHons before therapy is started. You must know which toxic reactions require contacting Hie primary healHi care provider immediately. Take penicillamine on an empty stomach, 1 hour before or 2 hours after a meal. If other drugp are prescribed, penicillamine is taken 1 hour apart from any other drug. Observe skin areas over Hie elbows, shoulders, and buttocks for evidence of bruising, bleeding, or break in the skin (delayed wound healing may occur). If Hiese occur, do not self-treat the... 

Adverse Side Effects. Penicillamine is considered to be fairly toxic when compared with other DMARDs.68 Side effects that have been reported as occurring more frequently include fever, joint pain, skin rashes and itching, and swelling of lymph glands. Other adverse effects that may occur less frequently... 

In addition to penicillamine nephropathy, other side effects of the drug may be related to the widespread deposition of immune complexes (Figure 3). Dense, granular immunoglobuhn deposits have been identified at the epidermodermal junction in 4 rheumatoid arthritis patients who developed toxic reactions, such as severe rashes, thrombocytopenia, aplastic anemia, and proteinuria. Three of 4 penicillamine-induced systemic lupus erythematosus syndrome patients had similar findings on skin biopsy [161]. 

Quinoline antimalarials such as hydroxychloroquine (Fig. 5-6) and chloroquine have been found to have antiarthritic properties however, the onset of clinical improvement, as with penicillamine and gold, takes months. Irreversible retinopathy, including retinal opacity, can be encountered. Lesser toxicities include skin pigmentation and alopecia. Proposals to possible mechanisms of action are speculative at best. It should be emphasized that none of the slow-action antiarthritic agents discussed earlier should be considered as initial therapy in RA. The salicylates and other NSAIDs deserve this distinction. If results are unsatisfactory gold may be considered as the subsequent therapeutic step. Penicillamine would be a logical alternate, as would short-term steroids or cytotoxic agents. 

Chelating agents, like all chemical compounds, exhibit toxic effects. These can arise from the fact that they increase the excretion of essential trace elements or from more subtle interactions. Thus all compounds which contain sulfhydryl compounds are capable of causing allergic reactions, such as the skin rash reported for DMSA (Grandjean et al. 1991), or the numerous problems which may arise from the continued administration of d-penicillamine such as nephrotic syndrome and anuria (Dubois et al. 1990). The administration of EDTA by itself may result in tetany due to the rapid drop in serum calcium which results, this being the reason for its customary administration as the calcium complex. 

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