Wilson's disease: Revisiting an old friend

Table 5 Adverse effects of medical therapy used in the treatment of Wilson’s disease

Medication	Side effects
D penicillamine	Early (1-3 wk):
	Fever, cutaneous eruptions, myelosuppression, lymphadenopathy, proteinuria
	Late: (> 3 wk-yr)
	Renal: Nephrotoxicity, nephrotic syndrome
	Lungs: Goodpasture syndrome
	Bone marrow: Aplasia
	Eye: Optic neuritis, retinitis
	Skin: Pemphigus, pemphigoid lesions, aphthous stomatitis, hair loss
	Autoimmunity: Lupus erythematosus, myasthenia gravis, polymyositis, immunoglobulin A depression
	Dose-dependent:
	Pyridoxine deficiency
	Mammary hypertrophy
	Skin: Elastosis serpiginosa, lichen planus, progeria-like skin changes
	Neurological deterioration (10%-50%)
Trientine	Few side effects:
	Bone marrow depression
	Sideroblastic anemia
	Hemorrhagic gastritis, loss of taste, and skin rash
	Neurological deterioration is less common
Zinc	Very few side effects:
	Gastric irritation
	Elevation of serum amylase and lipase
	Bone marrow depression
	Neurological deterioration is very uncommon
Tetrathiomolybdate	Few side effects:
	Bone marrow suppression
	Increased serum aminotransferase levels
	Anemia
	No neurological deterioration