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Penicillamine


- Dose: 
- maximum dose for RA patients is 750 mg to 1 g per day;

- low doses (125-250 mg) of the drug are used initially with slow-dose titration to reduce the potential for side effects. 
- D-penicillamine exhibits similar toxicity profile to IM gold, which includes mucocutaneous reactions, proteinuria, nephrotic syndrome, leukopenia, thrombocytopenia, and rarely, aplastic anemia. 
- may cause autoimmune reactions, SLE, myasthenia gravis, polymyositis, & Goodpasture's syndrome.