Myelotoxicity of D-penicillamine.

The dynamics of macrophage lineage populations in inflammatory and autoimmune diseases

“…Particularly for the first 3 drugs, myelosuppression can be a problem (86,(121)(122)(123). Similar to the findings of the studies of methotrexate referred to above (118,119), in RA patients receiving sulfasalazine, moderate reductions in leukocyte counts were correlated with reduced disease severity (123).…”

A case report and focused literature review of d‐penicillamine and severe neutropenia: A serious toxicity from a seldom‐used drug

“…Indeed, much of the safety literature surrounding the use of d ‐penicillamine relates to its treatment of patients with RA in the 1970s‐80s. The association between d ‐penicillamine and severe neutropenia, including case reports of patients diagnosed with aplastic anemia, has been extensively described in this population with fatalities reported . In Wilson's disease, where the overall toxicity is purported to be less, the literature includes fewer descriptions of very low neutrophil counts .…”

“…d ‐Penicillamine is associated with a variety of adverse drug effects affecting numerous organs, including the skin, kidneys, and nervous system . However, some of the most serious adverse effects are hematologic, including severe neutropenia (absolute neutrophil count [ANC] < 500 mm 3 ) …”

Acquired sideroblastic anaemia associated with penicillamine therapy for rheumatoid arthritis.

“…Acquired sideroblastic anaemia associated with penicillamine therapy for rheumatoid arthritis Penicillamine has been successfully used in the treatment of rheumatoid arthritis since 1964.1 2 Most of the serious reactions have been haematological and include agranulocytosis, thrombocytopenia, and aplastic anaemia.2 5 The incidence of some adverse side effects, such as thrombocytopenia, rashes and proteinuria, has been shown to be unacceptably high with high dose treatment. 4 We report a case of acquired sideroblastic anaemia following treatment with penicillamine for rheumatoid arthritis.…”