Kidney stones

CNS -   Myastenic syndrome in 1 in 50 patients

Dermatologic-   pharynigitis,   oral ulcers,  rash,  ecchymosis,  pruritus,  urticaria, warts,
                           skin wrinkling,  pemphigus,  elastosis,  perforans serpiginosis in 1in  6 patients

GI -  nausea, emesis, or softstools, anorexia, abdominal pain, bloating, or flatus in 1 in 6 patients

Hematologic-   increased bleeding, anemia,   leukopenia,  thrombocytopenia,  eosinophillia,
                          in about 1 in 25 patients

Hepatic -     jaundice and abnormal liver function tests have been reported during tioprotin therapy

Hypersensitivity-   laryngeal edema,  dyspnea, respiratory distress , fever, chills,  arthalgia,
                                weakness, fatigue,  myalgia,  adenopathy, in about 1 in 25 patients  

Pulmonary -         bronchiolitis, hemoptysis, pulmonary infiltrates, dyspnea in 1 in 50 patients

Renal -             protenuria, nephrotic syndrome, hematuria in about 1 in 20 patients

Special senses-  impairment in taste, and smell in about 1 in 25 patients. These reactions are
                              more likely to occur in patients who had previuosly shown toxicity to
                              d-penicillamine
                              Treatment with tioprotin should be stopped if severe toxicity develops.  

Use of tioprotin during pregnancy is contraindicated except in severe patients with cystinuria
when the anticipated benefit of inhibited kidney stones formation clearly outweighs the possible
hazards to the patient

Special Precaution-
Tioprotin may potentially cause all the serious advrse reactions reported for d-penicillamine
Though no direct death has been reported as a result directly from tioprotin treatment, a fatal
outcome of  from tioprotin is possible as has been reported with d-penicillanase therapy
 as aplastic anemia, agranulocytosis, thrombocytopenia 

Hematologic effect-  leukopenia of the granulocytic series may develop without eosinophillia
Patients should be adviced to report any signs of hematological abnormalities such as fever,
bleeding, or easy bruisability

Proteinuria - sometimes sufficiently severe to cause nephrotic syndrome may develop from
membranous glmerulopathy. A close observation of patients is mandatory

Complications- apperance of myasthenia gravis reqires cessation of treatment . When
pemphigus -type reaction develop tioprotin therapy should be stopped.

Pregnancy-  tioprotin should not be used during pregnancy

Lactation- because of potential serious adverse reactions of nursing infants from tioprotin,
mothers taking tioprotin should not nurse their infants

Children-  safety and effectiveness below the age 9 years have not been established 

Monitoring- to help monitor the following tests are recommended-
peripheral blood counts, direct platelet count, hemoglobin , serum albumin, liver function tests
24 hour urinary protein and routine urine analysis a 3 to 6 month intervals during treatment   

Indication-
Kidney stones

Dosage-
At least 3litre  of fluid ( 10 oz. glassfuls should be provided. including 2 glasses with each meal and
bed time.
The patient is expected to awake at night to urinate they should drink 2 more glasses of fluid before
returning to bed.
Additional fluids should be consumed if there is excessive sweating and fluid loss.
A minimum urine output of 2L/.day on a consisistent basis should be sought.

Pregnancy-
Tioprotin should not be used during pregnancy

Lactation-
Because of potential serious adverse reactions of nursing infants from tioprotin,
mothers taking tioprotin should not nurse their infants

Children-
Safety and effectiveness below the age 9 years have not been established