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