Pharmacology and Mechanism of Action

D-Penicillamine (D-Pa) is an amino acid with a thiol side-chain. The serum half-life is approximately two to four hours, although this increases to four to six days (45) in patients on long-term therapy. Its bioavailability is severely reduced if taken with food. The mechanism of action is unclear, although it is thought to act by inhibiting leucocyte myeloper-oxidases and by effecting T-cell proliferation (37,45). It has also been postulated that the thiol side-chain acts as a metal chelator with subsequent effects on cell surface receptors (37). Although efficacious for the treatment of RA (45), it has been generally superseded by other DMARDs because of problems with side effects and toxicity.

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