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Generic name: penicillaminepen-ih-SILL-ah-meen ]
Brand names: Cuprimine, Depen, D-Penamine
Drug class: Antirheumatics

Medically reviewed by on Apr 14, 2022. Written by Cerner Multum.

What is D-Penamine?

D-Penamine is a chelating (KEE-late-ing) agent that binds to excess copper and removes it from the blood stream. In certain conditions, excess copper can build up in the blood stream, leading to tissue damage throughout the body.

D-Penamine is used to remove excess copper in people with an inherited condition called Wilson's disease.

D-Penamine is also used to reduce urine levels of an amino acid called cystine, which can cause stones to form in the kidneys and bladder in people with an inherited condition called cystinuria.

D-Penamine is also used to treat severe rheumatoid arthritis after other medicines have been tried without success. This medicine is not approved to treat juvenile rheumatoid arthritis.

D-Penamine may also be used for purposes not listed in this medication guide.


You should not use D-Penamine if you are breast-feeding, if you have ever had an infection or damaged blood cells caused by this medicine, or if you have kidney disease and you need this medicine to treat rheumatoid arthritis.

Every person taking D-Penamine should remain under the close supervision of a doctor.

Before taking this medicine

You should not use D-Penamine if you are allergic to it, or if:

  • you are breast-feeding;

  • you have kidney disease (if using D-Penamine to treat rheumatoid arthritis); or

  • you have developed an infection or damaged blood cells after taking D-Penamine in the past.

Some medicines can cause unwanted or dangerous effects when used with D-Penamine. Your doctor may change your treatment plan if you also use:

  • gold injections;

  • medicine to treat or prevent malaria; or

  • cancer medicine.

Tell your doctor if you have ever had:

Follow your doctor's instructions about taking D-Penamine if you are pregnant. Do not start or stop taking D-Penamine without your doctor's advice, and tell your doctor right away if you become pregnant.

  • D-Penamine may cause harm to an unborn baby and should not be used to treat cystinuria or rheumatoid arthritis if you are pregnant.

  • D-Penamine may be used during pregnancy to prevent a relapse of Wilson's disease. Not treating this condition during pregnancy can cause harmful or fatal effects on the mother. The benefit of preventing a relapse of Wilson's disease may outweigh any risks to the baby.

You should not breast-feed while using this medicine.

How should I take D-Penamine?

Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.

Take D-Penamine on an empty stomach, at least 1 hour before or 2 hours after a meal.

Drink plenty of liquids while you are taking D-Penamine.

Do not drink milk within 1 hour before or 1 hour after you take D-Penamine.

You will need frequent urine tests.

Your condition may seem to get worse for a short time when you first start taking this medicine. Do not change your doses or medication schedule without your doctor's advice. Every person taking D-Penamine should remain under the care of a doctor.

It may take up to 3 months before your rheumatoid arthritis symptoms improve. Keep using the medication as directed and tell your doctor if your symptoms do not improve.

You may need to follow a special diet while using D-Penamine. Follow all instructions of your doctor or dietitian. Learn about the foods to eat or avoid to help control your condition.

If you do stop taking D-Penamine for any reason, do not start taking it again until you talk to your doctor.

Your doctor may want you to take a multivitamin or take extra iron or vitamin B6 while you are taking D-Penamine. Take only the amount of supplements that your doctor has prescribed.

Store at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use.

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking D-Penamine?

Avoid taking other medicines at the same time you take D-Penamine. If you take an iron supplement, take it at least 2 hours before or 2 hours after you take this medicine. Iron can make it harder for your body to absorb this medicine.

Avoid taking mineral supplements, unless your doctor tells you to.

If you have Wilson's disease, avoid eating nuts, chocolate, molasses, liver, shellfish, mushrooms, broccoli, and cereals that are fortified with copper. Also avoid taking mineral supplements that contain copper. If your drinking water supply contains more than 0.1 mg of copper per liter, you may need to drink distilled or demineralized water.

D-Penamine side effects

Get emergency medical help if you have signs of an allergic reaction: hives, rash; swollen glands; difficult breathing; swelling of your face, lips, tongue, or throat.

D-Penamine may cause serious side effects. Call your doctor at once if you have:

  • new or worsening joint pain;

  • muscle weakness in your arms and legs;

  • muscle weakness in your face, drooping eyelids, double vision, trouble chewing or swallowing;

  • new or worsening cough, fever, trouble breathing;

  • blisters or ulcers in your mouth, red or swollen gums, trouble swallowing;

  • skin rash, peeling, or watery blisters;

  • pain or burning when you urinate, foamy or bloody urine, lower back pain;

  • swelling in your hands, legs, and feet; or

  • low blood cell counts--fever, chills, tiredness, skin sores, easy bruising, unusual bleeding, pale skin, cold hands and feet, feeling light-headed or short of breath.

Common side effects of D-Penamine may include:

  • decreased sense of taste;

  • skin changes such as wrinkling or pimples;

  • stomach pain, nausea, vomiting, diarrhea, loss of appetite;

  • numbness or tingly feeling;

  • ringing in your ears; or

  • a wound that will not heal.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect D-Penamine?

Other drugs may affect D-Penamine, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all your current medicines and any medicine you start or stop using.

Further information

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.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.