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penicillamine

Generic Name: penicillamine (pen ih SILL ah meen)
Brand Name: Cuprimine, Depen

What is penicillamine?

Penicillamine is a chelating agent. It attaches to other chemicals in the body, which aids in their removal.

Penicillamine is used to remove excess copper associated with Wilson's disease. It is also used to reduce cystine in the urine and to treat severe rheumatoid arthritis.

Penicillamine may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about penicillamine?

Notify your doctor immediately if you develop fever; chills; a sore throat; unusual bruising or bleeding; blood in your urine, unexplained shortness of breath, coughing, or wheezing; muscle weakness; or double vision. These symptoms could be early signs of dangerous side effects.

Video: Treatment Options for Rheumatoid Arthritis

Doctor Ariel D. Teitel discusses several treatments that can help control the progression of the disease and help to alleviate the swelling and pain.

What should I discuss with my healthcare provider before taking penicillamine?

You cannot take penicillamine if you have taken it in the past and it has damaged your blood cells.

Before taking penicillamine, tell your doctor if you have kidney disease or any other serious illness. You may not be able to take penicillamine, or you may require a lower dose or special monitoring during therapy.

Penicillamine may cause birth defects in an unborn baby. However, it has also been used during pregnancy with no evidence of defects. Penicillamine should not be used during pregnancy except to treat Wilson's disease and some cases of cystine in the urine. Do not take this medication without first talking to your doctor if you are pregnant.

It is not known whether penicillamine passes into breast milk. Since penicillamine may harm a nursing infant, breast-feeding is not recommended during treatment with this medication.

How should I take penicillamine?

Take penicillamine exactly as directed by your doctor. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you.

Take each dose with a full glass of water.

Penicillamine must be taken on an empty stomach, at least 1 hour before or 2 hours after a full meal, and at least 1 hour before or after any other drug, food, or milk. Taking penicillamine with anything else in the stomach greatly decreases its effectiveness.

Do not stop taking penicillamine without first talking to your doctor. Stopping therapy may cause your body to react abnormally when therapy is restarted. If you do stop taking the medication, do not restart without first talking to your doctor. You may need special monitoring.

Your doctor may want you to take a vitamin and mineral supplement during treatment with penicillamine. Penicillamine may reduce vitamin B6 and iron in the body. Follow your doctor's instructions.

Store penicillamine at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose on an empty stomach as soon as you remember. However, if it is almost time for your next dose, skip the dose you missed and take only your next regularly scheduled dose. Do not take a double dose of this medication unless otherwise directed by your doctor. If you have missed several doses in a row, do not take any more doses without first talking to your doctor.

What happens if I overdose?

Seek emergency medical attention.

Symptoms of a penicillamine overdose are not known.

What should I avoid while taking penicillamine?

Follow any special diet restrictions recommended by your doctor.

Penicillamine side effects

If you experience any of the following serious side effects, seek emergency medical attention or contact your doctor immediately:

  • an allergic reaction (shortness of breath; closing of your throat; difficulty breathing; swelling of your lips, face, or tongue; or hives);

  • fever or chills;

  • a sore throat;

  • unusual bleeding or bruising;

  • blood in the urine;

  • unexplained shortness of breath, coughing, or wheezing;

  • abdominal pain;

  • yellow skin or eyes;

  • muscle weakness; or

  • double vision.

Other, less serious side effects may be more likely to occur. Continue to take penicillamine and notify your doctor if you experience

  • itching or a rash;

  • nausea, vomiting, diarrhea, or decreased appetite;

  • ringing in the ears;

  • decreased taste;

  • sores in the mouth;

  • poor wound healing; or

  • increased wrinkling of the skin.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Penicillamine dosing information

Usual Adult Dose for Wilson's Disease:

Initial dose: 0.75 to 1.5 grams/day that results in an initial 24-hour cupriuresis of over 2 mg should be continued for about three months.

Maintenance dose: The optimal maintenance dosage can be determined by measurement of urinary copper excretion and determination of free copper in the serum. It is seldom necessary to exceed a dosage of 2 g/day.

Total daily dose should be divided into four equal doses. If four equal doses are not feasible, give the larger portion at bedtime.

Usual Adult Dose for Cystinuria:

Usual adult dose: 2 grams/day with a range of 1 to 4 grams/day. The total daily dose should be divided into four doses. If four equal doses are not feasible, give the larger portion at bedtime.

Usual Adult Dose for Rheumatoid Arthritis:

Initial dose: Begin with a single daily dose of 125 mg or 250 mg, which is thereafter increased at one to three month intervals, by 125 mg or 250 mg/day, as patient response and tolerance indicate.

Maintenance dose: The maintenance dosage must be individualized, and may require adjustment during the course of treatment. Many patients respond satisfactorily to a dosage within the 500 to 750 mg/day range.

If there is no improvement and there are no signs of potentially serious toxicity after two to three months of treatment with doses 500 to 750 mg/day, increases of 250 mg/day at two to three month intervals may be continued until remission, toxicity develops, and/or there is no discernible improvement after three to four months of treatment with 1000 to 1500 mg of penicillamine per day.

Usual Pediatric Dose for Wilson's Disease:

Initial dose: 0.75 to 1.5 grams/day that results in an initial 24-hour cupriuresis of over 2 mg should be continued for about three months.

Maintenance dose: The optimal maintenance dosage can be determined by measurement of urinary copper excretion and determination of free copper in the serum. It is seldom necessary to exceed a dosage of 2 g/day.

Total daily dose should be divided into four equal doses. If four equal doses are not feasible, give the larger portion at bedtime.

Usual Pediatric Dose for Cystinuria:

Usual pediatric dose: 30 mg/kg/day. The total daily dose should be divided into four doses. If four equal doses are not feasible, give the larger portion at bedtime.

Usual Pediatric Dose for Rheumatoid Arthritis:

Initial dose: Begin with a single daily dose of 125 mg or 250 mg, which is thereafter increased at one to three month intervals, by 125 mg or 250 mg/day, as patient response and tolerance indicate.

Maintenance dose: The maintenance dosage must be individualized, and may require adjustment during the course of treatment. Many patients respond satisfactorily to a dosage within the 500 to 750 mg/day range.

If there is no improvement and there are no signs of potentially serious toxicity after two to three months of treatment with doses 500 to 750 mg/day, increases of 250 mg/day at two to three month intervals may be continued until remission, toxicity develops, and/or there is no discernible improvement after three to four months of treatment with 1000 to 1500 mg of penicillamine per day.

What other drugs will affect penicillamine?

Do not take penicillamine if you are taking any of the following medicines:

  • a gold-therapy product such as auranofin (Ridaura), aurothioglucose (Solganal), or gold sodium thiomalate (Myochrysine, Aurolate);

  • an antimalarial medicine such as quinine (Quinamm), mefloquine (Lariam), chloroquine (Aralen), hydroxychloroquine (Plaquenil), primaquine, or pyrimethamine (Daraprim);

  • a cancer chemotherapy medicine; or

  • phenylbutazone.

Like penicillamine, the medications listed above can affect the blood and the kidneys. Combined with penicillamine, any of these medicines can be very dangerous.

Before taking penicillamine, tell your doctor if you are taking digoxin (Lanoxin, Lanoxicaps). Penicillamine may decrease the effects of digoxin, and your doctor may want to adjust your dosage or monitor your therapy.

Many other drugs, especially antacids and vitamin and mineral supplements, can decrease the effects of penicillamine. Do not take any medicines or over-the-counter drugs or supplements within 1 hour of a penicillamine dose.

Drugs other than those listed here may also interact with penicillamine. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.

Where can I get more information?

  • Your pharmacist has additional information about penicillamine written for health professionals that you may read.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 2.03. Revision Date: 2010-12-15, 5:01:39 PM.

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