Penicillamine

Oral health effects

• Taste loss & pemphigus-like mucosal lesions

  Causes dysgeusia/ageusia (zinc/copper chelation) and can induce pemphigus- or lichenoid-like oral mucosal lesions.

  Clinical management: Biopsy/refer for blistering mucosal lesions; coordinate with the physician.

• Mouth ulcers, glossitis and cheilosis

  Oral ulcerations, sometimes resembling aphthous stomatitis, are reported; they often recur on rechallenge and may clear at a lower dose. Cheilosis, glossitis and gingivostomatitis are rarer (label).

  Clinical management: Report new or recurrent ulceration to the prescriber (dose-related; may need adjustment); provide symptomatic care and distinguish from pemphigus-like lesions.

• Delayed wound healing

  Penicillamine affects collagen and elastin; the label advises reducing the dose before surgery and delaying full dosing until wound healing is complete.

  Clinical management: Coordinate extractions or periodontal surgery with the prescriber regarding peri-operative dose reduction; monitor healing closely.