Clinical adverse events on penicillamine

• Rash

Often non-specific erythematous dry & itchy. Stop drug if severe. Stop drug if bullous reaction occurs. Consider using 1% hydrocortisone and/or antihistamines. Consider other causes. If mild re-introduce when settled.

• Mouth ulcers/Stomatitis

Stop if severe, reduce dose if mild/moderate. Consider carbenoxalone or difflam mouth washes. Consider other causes, check white cell count

• Loss of taste

Common early in treatment. Usually reappears with time or when drug stoppped.

• Metallic taste

Common early in treatment. Usually reappears with time or when drug stoppped. Stop if unacceptable.

• Nausea

Reduce dose and take with food. Stop if unacceptable.

• Lupus syndrome

Rare and difficult to diagnose. Stop drug and seek advice.

• Dyspnoea/Bronchiolitis

Stop drug and seek advice

• Myaesthenic symptoms

Stop drug and seek advice