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Penicillamine Side Effects

In Summary

Commonly reported side effects of penicillamine include: glossitis, cheilosis, oral mucosa ulcer, epigastric pain, dysgeusia, and ageusia. Other side effects include: thrombocytopenia. See below for a comprehensive list of adverse effects.

For the Consumer

Applies to penicillamine: oral capsule, oral tablet

As well as its needed effects, penicillamine may cause unwanted side effects that require medical attention.

Severity: Moderate

If any of the following side effects occur while taking penicillamine, check with your doctor or nurse as soon as possible:

More common:
  • Fever
  • joint pain
  • lesions on the face, neck, scalp, and/or trunk
  • skin rash, hives, or itching
  • swollen and/or painful glands
  • ulcers, sores, or white spots on lips or in mouth
Less common:
  • Bloody or cloudy urine
  • shortness of breath, troubled breathing, tightness in chest, or wheezing
  • sore throat and fever with or without chills
  • swelling of face, feet, or lower legs
  • unusual bleeding or bruising
  • unusual tiredness or weakness
  • weight gain
  • Abdominal or stomach pain (severe)
  • blisters on skin
  • bloody or black, tarry stools
  • chest pain
  • coughing or hoarseness
  • dark urine
  • difficulty in breathing, chewing, talking, or swallowing
  • eye pain, blurred or double vision, or any change in vision
  • general feeling of discomfort or illness or weakness
  • lower back or side pain
  • muscle weakness
  • painful or difficult urination
  • pale stools
  • pinpoint red spots on skin
  • redness, tenderness, itching, burning, or peeling of skin
  • red or irritated eyes
  • red, thick, or scaly skin
  • ringing or buzzing in the ears
  • spitting blood
  • yellow eyes or skin

Minor Side Effects

Some penicillamine side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

More common:
  • Diarrhea
  • lessening or loss of sense of taste
  • loss of appetite
  • nausea or vomiting
  • stomach pain (mild)

For Healthcare Professionals

Applies to penicillamine: oral capsule, oral tablet

Nervous system

Nervous system side effects have included tinnitus, myasthenia gravis, polyradiculopathy (rare), peripheral sensory and motor neuropathies (including polyradiculoneuropathy). Muscular weakness may or may not occur with the peripheral neuropathies.[Ref]


Ocular side effects have included reversible optic neuritis with racemic penicillamine (may be related to pyridoxine deficiency).[Ref]


Gastrointestinal side effects have included anorexia, epigastric pain, nausea, vomiting, and occasional diarrhea (17%). Some patients may report a blunting, diminution, or total loss of taste perception (12%); or may develop oral ulcerations. Although rare, cheilosis, glossitis, and gingivostomatitis have been reported.[Ref]


Hematologic side effects have included thrombocytopenia (4%), leukopenia (2%), and bone marrow depression. Fatalities have been reported as a result of thrombocytopenia, agranulocytosis, aplastic anemia, and sideroblastic anemia.[Ref]


Renal side effects have included proteinuria (6%) and/or hematuria which, in some, may progress to the development of the nephrotic syndrome as a result of an immune complex membranous glomerulopathy. Renal failure and a severe and ultimately fatal renal vasculitis have also been reported.[Ref]


Musculoskeletal side effects have included myasthenia gravis and dystonia.[Ref]


Dermatologic side effects have included skin friability, excessive wrinkling of skin, toxic epidermal necrolysis, anetoderma, development of small white papules at venipuncture and surgical sites, lichen planus, and bullous pemphigoid.[Ref]


Respiratory side effects have included allergic alveolitis, obliterative bronchiolitis, interstitial pneumonitis, pulmonary fibrosis, and bronchial asthma.[Ref]


Other side effects have included hyperpyrexia, alopecia, and Goodpasture's syndrome.[Ref]

The chelating action of the drug may cause increased excretion of other heavy metals such as zinc, mercury, and lead.[Ref]


Local side effects have included thrombophlebitis.[Ref]


Genitourinary side effects have included mammary atrophy.[Ref]


Immunologic side effects have included polymyositis and dermatomyositis.[Ref]


There have been reports associating penicillamine with leukemia. However, circumstances involved in these reports are such that a cause and effect relationship to penicillamine has not been established.[Ref]


1. "Product Information. Cuprimine (penicillamine)." Merck & Co, Inc, West Point, PA.

It is possible that some side effects of penicillamine may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.

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