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Criteria for Immediate Termination of D-Penicillamine Therapy for Lead Poisoning

Description

D-penicillamine is an oral chelating agent that can be given over a long period to children with blood iron levels < 45 µg/dL. As many as a third of patients taking the drug may have an adverse side effect. Patients taking D-penicillamine should be monitored closely and the drug stopped if evidence of a serious side effect is seen.


 

Important side effects:

(1) hypersensitivity reactions, with rashes and/or eosinophilia

(2) cytopenias

(3) renal dysfunction

(4) anorexia, nausea, bloating

(5) hepatocellular enzyme elevations

 

Monitoring tests:

(1) CBC

(2) urinalysis

(3) renal function tests

(4) liver function tests

 

Criteria for immediate discontinuation of D-penicillamine therapy

(1) An increase in blood level associated with evidence of ongoing lead exposure.

(2) Otherwise unexplained, generalized urticarial rash.

(3) Platelet count < 100,000 per µL.

(4) White blood cell count < 3,000 per µL.

(5) Abnormal urinalysis

(5a) proteinuria: > 1+ on dipstick

(5b) hematuria: > 10 RBCs per high power field

(5c) pyuria: > 10 WBCs per high power field

 


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