{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T22:50:40Z","timestamp":1777416640451,"version":"3.51.4"},"reference-count":33,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2000,1,1]],"date-time":"2000-01-01T00:00:00Z","timestamp":946684800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Ann Pharmacother"],"published-print":{"date-parts":[[2000,1]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Oral chelation therapy with d-penicillamine (d-PCN) has been proven to be effective in the treatment of mild-to-moderate lead poisoning. However, d-PCN is associated with a relatively high incidence of adverse effects when given in the standard dose of 25\u201330 mg\/kg\/d. Lower doses of d-PCN may reduce the rate of adverse effects without a significant reduction in the drug's efficacy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE:<\/jats:title>\n                    <jats:p>To examine the incidence of rash, white blood cell and platelet count depression, and abnormal urinalysis with d-PCN when given in a dose of 15 mg\/kg\/d to children with blood lead concentrations &lt;40 \u03bcg\/dL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>Retrospective analysis of a clinical treatment course of children who received d-PCN during 1996 in the Lead and Toxicology Clinic of Children's Hospital, Boston. All children were treated under a reduced-dose d-PCN chelation protocol.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      During the study period, 55 children (mean age 37.4 mo) received 66 courses of d-PCN. Mean blood lead concentration before chelation was 24 \u03bcg\/dL (range 15\u201337), with a corresponding erythrocyte protoporphyrin concentration of 42 \u03bcg\/dL. After 77 days of treatment with d-PCN, blood lead concentration was reduced to mean 16 \u03bcg\/dL (mean fall 35%; p = 0.005) and erythrocyte protoporphyrin was reduced to 28 \u03bcg\/dL (p = 0.009). During chelation therapy, the white blood cell count fell below 5000\/mm\n                      <jats:sup>3<\/jats:sup>\n                      in seven cases (9.7%); there were no episodes of platelet counts falling below 150 000\/mm\n                      <jats:sup>3<\/jats:sup>\n                      . No cases of abnormal urinalysis were reported; three episodes of rash (4.5%) were recorded. The only patients prematurely terminated from therapy were those who developed rash; in all three cases, drug eruption was an isolated occurrence, which resolved within 48 hours of diphenhydramine therapy. All adverse effects were transient and resolved during or immediately after chelation therapy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Reduced-dose d-PCN appears to maintain efficacy at reducing blood lead concentrations. Reduced-dose d-PCN also appears to be associated with a rate of adverse effects lower than previously reported; observed adverse effects appear to be benign and transient.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1345\/aph.19084","type":"journal-article","created":{"date-parts":[[2003,6,3]],"date-time":"2003-06-03T16:45:30Z","timestamp":1054658730000},"page":"15-18","source":"Crossref","is-referenced-by-count":22,"title":["Adverse Effects of Reduced-Dose d-Penicillamine in Children with Mild-to-Moderate Lead Poisoning"],"prefix":"10.1177","volume":"34","author":[{"given":"Michael W","family":"Shannon","sequence":"first","affiliation":[{"name":"Michael W Shannon MD MPH, Associate Chief of Emergency Services, and Director, The Pediatric Environmental Health Center, Children's Hospital, Boston, MA; and Associate Professor of Pediatrics, Harvard Medical School, Boston"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meaghan Kennedy","family":"Townsend","sequence":"additional","affiliation":[{"name":"Meaghan Kennedy Townsend, Research Assistant, Undergraduate Student, Harvard University, Boston"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2000,1,1]]},"reference":[{"key":"bibr1-aph.19084","first-page":"141","volume":"46","author":"Centers for Disease Control","year":"1997","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"bibr2-aph.19084","doi-asserted-by":"publisher","DOI":"10.1002\/tera.1420500508"},{"key":"bibr3-aph.19084","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198005153022006"},{"key":"bibr4-aph.19084","doi-asserted-by":"publisher","DOI":"10.1080\/00039896.1996.9935998"},{"key":"bibr5-aph.19084","doi-asserted-by":"publisher","DOI":"10.1080\/00039896.1996.9936003"},{"key":"bibr6-aph.19084","doi-asserted-by":"publisher","DOI":"10.1289\/ehp.94102s3215"},{"key":"bibr7-aph.19084","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(88)80216-6"},{"key":"bibr8-aph.19084","doi-asserted-by":"publisher","DOI":"10.1080\/00039896.1991.9934391"},{"key":"bibr9-aph.19084","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215100100519"},{"key":"bibr10-aph.19084","doi-asserted-by":"publisher","DOI":"10.1080\/00039896.1986.9935783"},{"key":"bibr11-aph.19084","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199207163270303"},{"key":"bibr12-aph.19084","doi-asserted-by":"publisher","DOI":"10.1001\/archpedi.1991.02160060099029"},{"key":"bibr13-aph.19084","volume-title":"Measuring lead exposure in infants, children and other sensitive populations","author":"National Research Council","year":"1993"},{"key":"bibr14-aph.19084","volume-title":"Lead poisoning in childhood","author":"Pueschel S","year":"1996"},{"key":"bibr15-aph.19084","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(84)80414-X"},{"key":"bibr16-aph.19084","unstructured":"Centers for Disease Control. Preventing lead poisoning in children. Atlanta, GA: Department of Health and Human Services, Public Health Service, 1991: 51\u201364."},{"key":"bibr17-aph.19084","doi-asserted-by":"publisher","DOI":"10.1542\/peds.96.1.155"},{"key":"bibr18-aph.19084","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(05)80618-3"},{"key":"bibr19-aph.19084","first-page":"493","volume":"30","author":"Chisolm JJ","year":"1992","journal-title":"Clin Toxicol"},{"key":"bibr20-aph.19084","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(68)80036-8"},{"key":"bibr21-aph.19084","doi-asserted-by":"publisher","DOI":"10.1542\/peds.46.3.389"},{"key":"bibr22-aph.19084","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(73)80547-5"},{"key":"bibr23-aph.19084","doi-asserted-by":"publisher","DOI":"10.1080\/00039896.1978.10667353"},{"key":"bibr24-aph.19084","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(88)83212-8"},{"key":"bibr25-aph.19084","doi-asserted-by":"publisher","DOI":"10.3928\/0090-4481-19941101-10"},{"key":"bibr26-aph.19084","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(88)80396-2"},{"key":"bibr27-aph.19084","doi-asserted-by":"publisher","DOI":"10.1111\/j.1651-2227.1971.tb06989.x"},{"key":"bibr28-aph.19084","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198910053211417"},{"key":"bibr29-aph.19084","doi-asserted-by":"publisher","DOI":"10.1016\/S0190-9622(83)70062-9"},{"issue":"7","key":"bibr30-aph.19084","first-page":"164","volume":"8","author":"Camp AV","year":"1981","journal-title":"J Rheumatol"},{"key":"bibr31-aph.19084","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197902083000602"},{"key":"bibr32-aph.19084","doi-asserted-by":"publisher","DOI":"10.1016\/S0013-9351(05)80203-8"},{"key":"bibr33-aph.19084","first-page":"79","volume-title":"Lead absorption in children: management, clinical and environmental aspects","author":"Hammond C","year":"1982"}],"container-title":["Annals of Pharmacotherapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1345\/aph.19084","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1345\/aph.19084","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T11:02:35Z","timestamp":1777374155000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1345\/aph.19084"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2000,1]]},"references-count":33,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2000,1]]}},"alternative-id":["10.1345\/aph.19084"],"URL":"https:\/\/doi.org\/10.1345\/aph.19084","relation":{},"ISSN":["1060-0280","1542-6270"],"issn-type":[{"value":"1060-0280","type":"print"},{"value":"1542-6270","type":"electronic"}],"subject":[],"published":{"date-parts":[[2000,1]]}}}