d-penicillamine: Chemistry and clinical use in rheumatic disease

The discovery of d-penicillamine and its uses in medicine are reviewed. Chemical-physical properties are discussed, and the molecular structure of d-penicillamine and several of its reaction products are illustrated. Examples of its three main types of biochemical reactions—sulfhydryl-disulfide exchange, thiazolidine formation, and metal chelation are included. Trials of d-penicillamine in RA patients are reviewed critically. The administration of the drug is discussed in detail, including dosages, clinical and laboratory responses, patterns of adverse side effects or toxicity, drug-induced autoimmune diseases, indications and contraindications, and the monitoring and management of patients.