• Oral administration of D-penicillamine to CD-1 mice causes neonatal mortality without morphologic defects.
• Osteolathyrogen-induced notochord malformation: an approach for relating chemical mixture toxicity and mechanisms of action.
• Renal disease and fluid balance in pregnancy.
• What is the evidence suggesting that antidotes are safe to use in the treatment of poisoning during pregnancy?
SIDE EFFECTS - Mild effects include fever, CNS depression, anorexia, nausea, vomiting, loss of taste, abdominal pain, and myalgia.
More serious adverse effects include nephrotic syndrome, hypersensitivity reactions, transient blood dyscrasias, aplastic anemia, neutrophilic agranulocytosis, neutropenia, thrombocytopenia, bronchiolitis obliterans, rashes, dystonia and various autoimmune responses (polymyositis, myasthenia gravis, SLE, Goodpasture's syndrome, thyroiditis).
INCIDENCE of adverse reactions in some studies has been as high as 62%, with 36% experiencing symptoms which necessitated discontinuation of therapy.
DOSE - Most of these toxic side effects occur with chronic administration. The relationship to dose is unclear, as even patients taking small doses may develop toxicity.
FORM - The L isomer and racemic mixture are more toxic than the D isomer.
The N acetylated form of DL-penicillamine has shown less toxicity than the DL mixture itself, and more similar to that of D-penicillamine. This form is still experimental, but has shown some promise.