A 19-year-old man with Wilson's disease started on D-penicillamine develops new-onset proteinuria and a falling platelet count after 4 months of therapy. Which drug should replace it?
- A British anti-lewisite (dimercaprol)
- B Zinc acetate monotherapy
- C Trientine ✓
- D Ammonium tetrathiomolybdate long term
Correct answer: C. Trientine
Explanation
Proteinuria and thrombocytopenia reflect penicillamine toxicity affecting kidney and marrow. Trientine is the standard alternative chelator with a similar copper-mobilizing efficacy and a better safety profile. Zinc acts slowly by blocking intestinal copper absorption and serves maintenance, not replacement of an effective chelator. Tetrathiomolybdate is reserved for initial neurologic disease and causes copper depletion if used long term.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.