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Miscellaneous Drugs during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Penicillamine (Cuprimine) is used to treat rheumatoid arthritis, but should not be used during pregnancy because it is a known teratogen. It is a chelating agent used to treat lead poisoning. However, its mechanism of action as an antirheumatoid agent is not understood. Penicillamine crosses the placenta and is contraindicated for use during pregnancy because it interrupts fetal collagen formation (Gimovsky and Montoro, 1991) and is considered a human teratogen (Shepard, 1989). Immunosuppressant drugs such as cyclosporine and azathioprine are used to treat rheumatoid arthritis that is refractory to high dose aspirin in non-pregnant patients (Kerstens et al., 1995; Kruger and Schattenkirchner, 1994). These agents should be reserved to treat pregnant women with severe disease refractory to more commonly used agents with which there is greater clinical experience and published data.
Papulosquamous Diseases
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Melek Aslan Kayıran, Jordan V. Wang, Ayşe Serap Karadağ
Differential diagnosis: LP can often be difficult to differentiate from lichenoid drug eruption, in which lesions are more frequently symmetrically distributed in sun-exposed areas with less oral involvement and without Wickham striae. Medication history in the last 2 years should be questioned. Common drugs include gold salts, antimalarials, beta-blockers, angiotensin-converting-enzyme inhibitors, penicillamine, nonsteroidal anti-inflammatory drugs, thiazide diuretics, spironolactone, and furosemide.
Monographs of Topical Drugs that Have Caused Contact Allergy/Allergic Contact Dermatitis
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
Penicillamine is the most characteristic degradation product of the penicillin antibiotics, but it has no antibacterial activity. Its pharmaceutical form is D-penicillamine, as L-penicillamine is toxic (it inhibits the action of pyridoxine). Penicillamine is a copper-chelating agent used in the treatment of Wilson’s disease. It is also used to reduce cystine excretion in cystinuria. Another indication of penicillamine is in the treatment of rheumatoid arthritis. It works by immunosuppression: reducing numbers of T-lymphocytes, inhibiting macrophage function, decreasing IL-1, and decreasing rheumatoid factor. This agent also prevents collagen from cross-linking (1). In ophthalmology, penicillamine used to be administered as eye drops in a 3% solution in water to prevent corneal fibrosis after chemical trauma (2,3). Currently, such eye drops are probably are not in use anymore.
Angiotensin II receptor blockers in dermatology: a narrative review
Published in Journal of Dermatological Treatment, 2022
ACEIs is one of the most common triggers for drug-induced pemphigus (DIP), but ARBs can also induce pemphigus (34–36), including telmisartan, valsartan, losartan and candesartan. However, it is difficult to differentiate between DIP and idiopathic pemphigus, due to the similar clinical and histologic features; furthermore, indirect immunofluorescence also cannot be used to differentiate between these two entities (34). Although a previous study revealed that immunostaining of a monoclonal antibody (32-2B) can be useful for the diagnosis of DIP and is an indicator of a good prognosis (35), it is rarely used in clinical practice. Some articles reported a good prognosis with thiol-induced pemphigus (36), but one review article reported no difference within thiol and non-thiol groups for the outcome (34). The time for remission varies for the drugs, according to the previous review article (34), the median time to remission for the cases induced by penicillamine is 90 days, and 60 days for the cases induced by captopril. The possible mechanism of ARBs for DIP is that nonthiol and nonphenol drugs lead to autoantibody production and the loss of keratinocyte adhesion (34). Studies have reported the appearance of lesions 2–6 months after ARBs administration (37–39). Furthermore, some case reports have revealed that ARBs induce bullous pemphigoid (40). However, diuretics were the most common antihypertensive drug contributing to BP (41,42), especially loop diuretics (42). Due to the high prevalence of hypertension in elderly patients, ARBs should be considered when dealing with DIP.
Investigation of Thiol/Disulfide Homeostasis and Ischemia-Modified Albumin Levels in Children with Wilson Disease
Published in Fetal and Pediatric Pathology, 2022
Ferit Durankuş, Yakup Albayrak, Yavuz Tokgöz, Ömer Faruk Beşer, Ramazan Durankuş, Sebahat Çam, Eda Sünnetçi, Ömer Akarsu, Cemil Nural, Özcan Erel
This study was designed as a multi-centered and cross-sectional type. The diagnosis of WD was based on the scoring system developed at the Eighth International Meeting on Wilson’s disease, in Leipzig, 2001; a score > 4 was considered reasonable for making a diagnosis of WD [17, 18]. Other diseases, including autoimmune liver disease, chronic viral hepatitis, α1-anti-trypsin deficiency, or other metabolic conditions, were ruled out in all participants. All patients were regularly followed up and treated with penicillamine. A total of 15 children with WD were included in the study. The control group participants (n = 25) were selected from the social pediatrics department from healthy children who were admitted for routine follow-up. All parents signed a written informed consent after being provided a detailed description of the study. The study was approved by the Local Clinic Research Ethical Committee.
Safety profile of D-penicillamine: a comprehensive pharmacovigilance analysis by FDA adverse event reporting system
Published in Expert Opinion on Drug Safety, 2021
Vijay Kumar, Anand Prakash Singh, Nicholas Wheeler, Cristi L. Galindo, Jong-Joo Kim
D-Penicillamine (D-pen) is a chelating agent that binds to and removes heavy metals (e.g. copper, iron, mercury, arsenic, and lead) from the bloodstream [1]. Its molecular formula is C5H11NO2S, IUPAC name is (2S)-2-amino-3-methyl-3-sulfanylbutanoic acid, and the molecular weight is 149.2 g/mol. D-Pen is available in generic forms and under the brand names of Cuprimine, Cuprenyl, Depen, and others. The thiol group (-SH) of D-pen is critical to its ability to function as a chelator [2]. In certain conditions, excess copper can build up in the bloodstream, leading to tissue damage throughout the body. D-pen was approved by the Food and Drug Administration (FDA) for the treatment of Wilson’s disease (Hepatolenticular Degeneration), cystinuria, and patients with severe, active rheumatoid arthritis (RA) who have failed to respond to an adequate trial of conventional therapy. It is also used as an off-label treatment option for lead poisoning in children.