Penicillamine use while Breastfeeding
Drugs containing Penicillamine: Cuprimine, Depen Titratabs, Depen
Penicillamine Levels and Effects while Breastfeeding
Summary of Use during Lactation
Limited information indicates that penicillamine is not detectable in breastmilk. Copper and zinc levels in breastmilk are reduced in mothers receiving penicillamine. Penicillamine has been used with apparent safety during nursing of 3 infants. In infants who breastfeed infrequently, taking the drug right after nursing and waiting 4 to 6 hours before nursing again should minimize the amount of penicillamine in breastmilk. Copper and zinc levels in breastmilk are reduced in patients taking penicillamine. The implications for infants of this effect are not known.
Maternal Levels. Four patients received penicillamine for Wilson's disease in dosages of 800, 600 (2 patients) and 500 mg daily. Penicillamine was not detectable by HPLC in the breastmilk of any of the mothers' milk samples.
Infant Levels. Relevant published information was not found as of the revision date.
Effects in Breastfed Infants
One woman taking penicillamine 1500 mg daily for cysteinuria breastfed her infant for 3 months with no apparent adverse effects in her infant.
Another woman breastfed 2 infants after 2 pregnancies while being treated for Wilson's disease with penicilliamine 750 mg daily. One infant had prolonged icterus that was unlikely to have been related to the penicillamine.
A center in Turkey reported 23 infants born to mothers with Wilson's disease over a 20-year period. Twenty-one were treated with penicillamine 600 mg and zinc 100 mg daily. All of the infants were breastfed (extent and duration not specified). One premature infant died at 3 weeks of age (maternal drug not specified), but the other infant had no apparent complications over a median of 51 months (range 13 to 105 months) of follow-up.
Effects on Lactation and Breastmilk
Milk concentrations of zinc and copper are reduced during therapy of Wilson's disease with penicillamine.
Alternate Drugs to Consider
1. Byron MA. Treatment of rheumatic diseases. Br Med J. 1987;294:236-8. PMID: 3101825
2. Ramsey-Goldman R, Schilling E. Optimum use of disease-modifying and immunosuppressive antirheumatic agents during pregnancy and lactation. Clin Immunother. 1996;5:40-58. DOI: doi:10.1007/BF03259314
3. Shiga K, Kaga H, Kodama H et al. Copper and zinc concentrations in the breast milk of mothers with Wilson disease and effects on infants. J Inherit Metab Dis. 2006;29 (Suppl 1):139. Abstract. DOI: doi:10.1007/s10545-006-9995-6
4. Izumi Y. [Can mothers with Wilson's disease give her breast milk to their infant?]. Teikyo Med J. 2012;35:17-24.
5. Kaga F, Kodama H, Siga K et al. Copper and zinc status in the breast milk of mothers with Wilson disease. J Inherit Metab Dis 2008;31 (Suppl 1):157. Abstract. DOI: doi:10.1007/s10545-008-9975-0
6. Gregory MC, Mansell MA. Pregnancy and cystinuria. Lancet. 1983;2:1158-60. PMID: 6139526
7. Messner U, Gunter HH, Niesert S. [Wilson disease and pregnancy. Review of the literature and case report]. Z Geburtshilfe Neonatol. 1998;202:77-9. PMID: 9654718
8. Demir K, Soyer OM, Karaca C et al. The course of pregnancy in Wilson's disease-one center, 20 years' experience. Gastroenterology. 2014;146:S-1009. Abstract TU1834.
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