Kelatine (D-Penicillamine)

D-Penicillamine acts as a heavy‑metal chelator and is used in several metabolic and inflammatory disorders.

• Wilson disease: reduces copper accumulation and helps prevent hepatic and neurological damage.
• Cystinuria: decreases urinary cystine stone formation by forming soluble complexes.
• Rheumatoid arthritis: lowers inflammatory activity by chelating metal ions involved in oxidative processes.

• D-Penicillamine chelates divalent metal ions such as copper, lead, and iron by forming stable, water‑soluble complexes that are eliminated in the urine. It also reduces disulfide bonds in proteins, altering their structure and function, which contributes to its therapeutic effects in metal‑overload conditions and certain autoimmune diseases.

Adverse reactions to D-Penicillamine can vary from mild to severe.

Common Side Effects

• Nausea: mild to moderate stomach upset.
• Vomiting: occasional episodes, especially at treatment initiation.
• Loss of appetite: reduced desire to eat.
• Metallic taste: persistent metallic sensation in the mouth.
• Rash: mild skin irritation or itching.
• Fatigue: general feeling of tiredness.

Serious or Rare Side Effects

• Agranulocytosis: severe drop in white blood cells.
• Aplastic anemia: bone‑marrow failure leading to pancytopenia.
• Severe skin reactions: Stevens‑Johnson syndrome or toxic epidermal necrolysis.
• Liver toxicity: elevated transaminases or hepatitis.
• Kidney dysfunction: impaired renal function or interstitial nephritis.
• Unexplained fever: may indicate systemic reaction.

Safety considerations for D-Penicillamine include regular monitoring and patient education.

• Monitor blood counts: perform regular CBC to detect cytopenias.
• Assess liver function: periodic LFTs are recommended.
• Check renal function: monitor serum creatinine and electrolytes.
• Avoid in patients with known hypersensitivity: discontinue if rash or angioedema occurs.
• Pregnancy and lactation: use only if benefits outweigh potential risks.
• Store at ambient temperature: keep in the original container, protect from moisture and light.

D-Penicillamine may interact with several medicines, requiring caution.

Major Interactions (Avoid)

• Zinc supplements: reduce absorption of D-Penicillamine.
• Iron preparations: chelate iron, decreasing its bioavailability.
• Methotrexate: increased risk of toxicity.
• Tetracycline antibiotics: may form complexes, reducing efficacy.

Moderate Interactions (Monitor Closely)

• ACE inhibitors: monitor blood pressure for additive hypotensive effect.
• NSAIDs: may increase risk of renal impairment when combined.