Table 2.

Characteristics of medications available for the treatment of Wilson’s disease [45,46,48,72,73,74,75].

Medication	Treatment Indications	Adverse Effects	Potency and Efficacy
Agents mobilizing copper from tissues and increasing its urinary excretion (chelators)
D -Penicillamine	First-line induction treatmen: the first oral chelating agent for WD treatment	Allergic reactions (fever and rash), lymphadenopathy, bone marrow suppression, lymphadenopathy, lupus-like syndrome, kidney dysfunction, and deterioration in neurological status	Very effective
Trientine	Second-line induction treatment: approved for patients intolerant of d-penicillamine	Autoimmune reactions, kidney dysfunction, bone marrow suppression, and deterioration in neurological status	Effective
Agents preventing copper absorption
Zinc salts	Maintenance treatment: first-line induction treatment in selected patient subgroups (neurologic WD variant, intolerant to chelators, pregnant women, and asymptomatic WD patients)	Stomach irritation and otherwise a low level of toxicity	Effective
Agents forming copper–albumin complexes (currently under evaluation)
Bis-choline tetra-thiomolybdate (TTM)	Planned for first-line induction treatment	Hepatitis and bone marrow suppression	Under assessment, very effective