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penicillamine

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

What is penicillamine?

Penicillamine 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.

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

Penicillamine 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.

Penicillamine is also used to treat severe rheumatoid arthritis after other medicines have been tried without success. Penicillamine is not approved to treat juvenile rheumatoid arthritis.

Penicillamine may also be used for purposes not listed in this medication guide.

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

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

Every person taking penicillamine should remain under the close supervision of a doctor.

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

You should not use penicillamine if you are allergic to it, or:

  • if you are breast-feeding;

  • if you have kidney disease (if using penicillamine to treat rheumatoid arthritis); or

  • if you have developed an infection or damaged blood cells after taking penicillamine in the past.

Some medicines can interact with penicillamine and should not be used at the same time. Your doctor may need to change your treatment plan if you use any of the following drugs:

  • gold injections;

  • medicine to treat or prevent malaria; or

  • drugs that weaken the immune system such as cancer medicine, steroids, and medicines to prevent organ transplant rejection.

To make sure penicillamine is safe for you, tell your doctor if you have:

  • kidney disease;

  • liver disease;

  • an allergy to penicillin;

  • a history of stomach ulcers;

  • a weak immune system; or

  • if you are malnourished.

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

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

  • Penicillamine 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.

It is not known whether penicillamine passes into breast milk or if it could harm a nursing baby. You should not breast-feed while using this medicine.

How should I take penicillamine?

Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not use this medicine in larger or smaller amounts or for longer than recommended.

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

Do not drink milk within 1 hour before or 1 hour after you take penicillamine.

While using penicillamine, you may need frequent blood and urine tests.

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.

Drink plenty of liquids while you are taking penicillamine.

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

Penicillamine may be only part of a complete program of treatment that also includes a special diet. Follow the diet plan created for you by your doctor or nutrition counselor. Get familiar with the list of foods you must avoid to help control your condition.

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 penicillamine should remain under the care of a doctor.

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

Your condition may need to be treated with a combination of drugs. Use all medications as directed by your doctor. Read the medication guide or patient instructions provided with each medication.

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 missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

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 penicillamine?

Follow any special diet restrictions recommended by your doctor. 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.

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

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

Penicillamine side effects

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

Call your doctor at once if you have:

  • sudden fever, skin rash, joint pain, or swollen glands;

  • sudden weakness or ill feeling, chills, sore throat, mouth sores, skin sores, red or swollen gums;

  • easy bruising or bleeding;

  • pale skin, feeling light-headed or short of breath, rapid heart rate;

  • 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;

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

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

Common side effects may include:

  • decreased sense of taste;

  • skin rash or peeling, watery blisters;

  • 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.

See also: Side effects (in more detail)

Penicillamine dosing information

Usual Adult Dose for Wilson's Disease:

-Initial dose: 0.75 to 1.5 g orally per day in 4 equal divided doses that results in an initial 24-hour cupriuresis of over 2 mg should be continued for about 3 months
-Maintenance dose: 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 per day

Comments:
-This drug should be taken on an empty stomach, 1 hour before or 2 hours after a meal.
-The total daily dose should be divided into 4 equal doses; if 4 equal doses are not feasible, the larger portion should be given at bedtime.
-Patients may require a daily supplement of pyridoxine because this drug increases the requirement for pyridoxine.
-Optimal dosage can be determined by measurement of urinary copper excretion and the determination of free copper in the serum. The urine should be collected in copper-free glassware, and should be quantitatively analyzed for copper before and soon after initiation of therapy.

Use: Wilson's disease

Usual Adult Dose for Cystinuria:

Usual dose: 2 g orally daily with a range of 1 to 4 g per day in 4 equal divided doses

Comments:
-This drug should be taken on an empty stomach, 1 hour before or 2 hours after a meal.
-The total daily dose should be divided into 4 equal doses; if 4 equal doses are not feasible, the larger portion should be given at bedtime.
-Patients should drink about a pint of fluid at bedtime and another pint once during the night when urine is more concentrated and more acid than during the day; the greater the fluid intake, the lower the required dosage of this drug.
-Dosage should be individualized to an amount that limits cystine excretion to 100 to 200 mg per day in those with no history of stones, and below 100 mg per day in those who have had stone formation and/or pain; in determining dosage, the inherent tubular defect, the patient size, age, and rate of growth, diet, and water intake all should be taken into consideration.
-The standard nitroprusside cyanide test may be useful as a qualitative measure of the effective dose.

Use: Cystinuria

Usual Adult Dose for Rheumatoid Arthritis:

-Initial dose: 125 or 250 mg orally once a day
-Titration: Increase at 1 to 3 month intervals by 125 or 250 mg per day, as response and tolerance indicate
-Maintenance dose: Should be individualized, and may require adjustment during the course of treatment; many patients respond satisfactorily to a dosage within the 500 to 750 mg per day range; changes in maintenance dosage levels may not be reflected clinically or in the erythrocyte sedimentation rate for 2 to 3 months after each dosage adjustment
-Maximum dose: If there is no discernible improvement after 3 to 4 months of therapy with 1 to 1.5 g per day, therapy should be discontinued

Comments:
-This drug should be taken on an empty stomach, 1 hour before or 2 hours after a meal.
-The total daily dose should be divided into 4 equal doses; if 4 equal doses are not feasible, the larger portion should be given at bedtime.
-The first evidence of a clinical response to this drug in rheumatoid arthritis patients may take 2 to 3 months.
-When therapy has been interrupted because of adverse reactions or other reasons, the drug should be reintroduced cautiously by starting with a lower dosage and increasing slowly.
-During the course of treatment some patients may experience an exacerbation of disease activity following an initial good response; these may be self-limited and can subside within 12 weeks. They are usually controlled by the addition of nonsteroidal anti-inflammatory drugs, and only if the patient has demonstrated a true "escape" phenomenon (as evidenced by failure of the flare to subside within this time period) should an increase in the maintenance dose ordinarily be considered.
-In the rheumatoid patient, migratory polyarthralgia due to this drug is extremely difficult to differentiate from an exacerbation of the rheumatoid arthritis. A substantial reduction in dosage or discontinuing therapy for up to several weeks will usually determine which of these processes is responsible for the arthralgia.

Use: Rheumatoid arthritis

Usual Pediatric Dose for Wilson's Disease:

Less than 18 years of age:
-Initial dose: 0.75 to 1.5 g orally per day in 4 equal divided doses that results in an initial 24-hour cupriuresis of over 2 mg should be continued for about 3 months
-Maintenance dose: 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 per day

Comments:
-This drug should be taken on an empty stomach, 1 hour before or 2 hours after a meal.
-The total daily dose should be divided into 4 equal doses; if 4 equal doses are not feasible, the larger portion should be given at bedtime.
-Patients may require a daily supplement of pyridoxine because this drug increases the requirement for pyridoxine.
-Optimal dosage can be determined by measurement of urinary copper excretion and the determination of free copper in the serum. The urine should be collected in copper-free glassware, and should be quantitatively analyzed for copper before and soon after initiation of therapy.

Use: Wilson's disease

Usual Pediatric Dose for Cystinuria:

Less than 18 years of age:
Usual dose: 30 mg/kg/day orally

Comments:
-This drug should be taken on an empty stomach, 1 hour before or 2 hours after a meal.
-The total daily dose should be divided into 4 equal doses; if 4 equal doses are not feasible, the larger portion should be given at bedtime.
-Patients should drink copious amounts of fluid.

Use: Cystinuria

What other drugs will affect penicillamine?

Other drugs may interact with penicillamine, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Where can I get more information?

  • Your doctor or pharmacist can provide more information about penicillamine.
  • 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: 3.02.

Date modified: June 01, 2017
Last reviewed: May 23, 2016

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