d-penicillamine: Chemistry and clinical use in rheumatic disease |
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| Authors: | Helen E Howard-Lock BSc PhD Professional Scientist Colin JL Lock ARCS BSc DIC PhD FCIC Professor of Chemistry Pathology Amirudin Mewa FRCP Walter F Kean MD FRCP FACP |
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| Institution: | Helen E. Howard-Lock BSc, PhD, Professional Scientist, Colin J.L. Lock ARCS, BSc, DIC, PhD, FCIC, Professor of Chemistry,Pathology, Amirudin Mewa FRCP (C),Walter F. Kean MD, FRCP (C), FACP, |
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| Abstract: | 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. |
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