Table 4.

Adverse Effects of Drugs Used in Treatment of Wilson's Disease.

Name of drug	Side effects
D-penicillamine	Early: (1–3 weeks) hypersensitivity Fever, cutaneous eruptions, lymphadenopathy, neutropenia, thrombocytopenia, and proteinuria Late: (3 weeks–3 months) hypersensitivity a)Renal: Lupus-like syndrome (proteinuria, hematuria, positive ANA) b)Lung: Goodpasture syndrome c)Bone Marrow: severe thrombocytopenia, total aplasia d)Skin: pemphigus, pemphigoid lesions involving skin, mouth, vagina, buccal ulcerations, apthous stomatitis, hair loss e)Eye: optic neuritis. Very late (after 1 year) Nephrotoxicity, severe allergy on restarting drug, myasthenia gravis, polymyositis (<1%), loss of taste, immunoglobulin A depression, retinitis, hepatotoxicity (transaminitis), copper depletion leading to neutropenia, sideroblastic anemia, and hemosiderosis Direct dose dependent: a)Pyridoxine deficiency b)Skin: elastosis perforans serpiginosa, lichen planus, progeria-like skin changes, D-penicillamine dermopathy a brownish discoloration of skin secondary to trauma-related subcutaneous bleed c)Mammary hypertrophy Neurological deterioration: Incidence ranges from 10% to 50%
Triethylenetetramine hydrochloride/trientine	Few side effects No hypersensitivity described Fixed drug eruption reported in one patient. Chelates iron: should not be coadministered with iron Bone marrow depression Sideroblastic anemia: reversible (iron and copper deficiency) Hemorrhagic gastritis, loss of taste, and skin rash Neurological deterioration is less common
Zinc	Very few side effects Gastric irritation: zinc sulphate > acetate Asymptomatic elevation of serum amylase and lipase Neurological deterioration is described but very uncommon

ANA, antinuclear antibody.