Treatment of chronic mercurialism with N-acetyl-penicillamine.

Abstract

I1 14; iisefulness of chelating and complexing T agc.nt,s in the treatment of heavy metal intoxicaticitia Ii:is received considerable attention since the w:i 1.1 iine development of dimercaptopropanol (BAI,) :IS an antidote for poisoning by arsenic c0ml)tiiiiicls. UAL has been found promisii:g in thr 1rwit.inent of acute mercury, as well a arsenic., illtoxication. Soon after World War 11, stutlic*s in Switzerland’ and the United States revc*:ilc*i I that EDTA (ethylene diamine tetraawi,it. :iceid), given intravenously, enhances grc*:itl\. 1110 excretion of lead and plutonium in a C O I I I ~ I I I ~ form. These findings have been amply vc.rifii*il, but both these agents have certain dr:i\vlitii.ks. EDTA is not effective in mercury poisotiinA; BAL is beneficial only by parented atlitiitiist.ration, is poorly tolerated and has been foiiiill c*tl”sctive only in acute mercury poisoning. 1{1~1wtIy it became known that penicillamine gi\vsrt liy mouth increases the elimination of rnc~t:il.i such as copper. Walshe2 first suggested t lw hi l l istitution of penicillamine for BAL in the trc-:i I i w n t of Wilson’s disease following experii i l twt 9 which indicated that penicillamine (B$dinivtliyl cysteine) in oral doses of 300 mg three titiicw tl:tily caused a twenty-fold increase in the urit 111 I. copper excretion of normal individuals. Hen I I I I I I I ~ also a marked increase in copper excretioti i t i six patients with Wilson’s disease who wiw* uiven daily doses of from 0.5 to 1.5 grams. 111 liis short term experiments he did not observe atiy ttrsic reaction with this drug and suggests, “( ) t i t Iicoretical grounds dimethyl cysteine may woll 1 1 1 s of use in the treatment of heavy metal poisiitiiiig with gold or mercury.” Aposhian and asst i t . i : i tcs3 have suggested N-acetyl-penicillamine as :I Ilrug which might be effective against mercury poisoning, based on their studies of its prolcv+,ive action against the acute effects of mcwiiric chloride in rats. ‘1’111. following data were obtained with a prep-