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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

Very common (10% or more): Blunting, diminution, or total loss of taste (12%)
Frequency not reported: Headache, dizziness, deterioration of neurological symptoms of Wilson's disease (dystonia, rigidity, tremor, dysarthria) following introduction of therapy in patients treated for this condition (this may be a consequence of mobilization and redistribution of copper from the liver to the brain), arthralgia, tinnitus, peripheral sensory and motor neuropathies (including polyradiculoneuropathy, i.e., Guillain-Barre Syndrome)[Ref]


Very common (10% or more): Epigastric pain (17%), nausea (17%), vomiting (17%), diarrhea (17%)
Rare (0.01% to 0.1%): Mouth ulceration, stomatitis, glossitis
Frequency not reported: Pancreatitis, reactivated peptic ulcer[Ref]


Common (1% to 10%): Thrombocytopenia, leukopenia
Frequency not reported: Neutropenia (usually reversible), agranulocytosis (sometimes fatal), aplastic anemia (sometimes fatal), hemolytic anemia, lymphadenopathy, thrombotic thrombocytopenic purpura, red cell aplasia, monocytosis, leukocytosis, eosinophilia, thrombocytosis[Ref]


Common (1% to 10%): Proteinuria
Rare (less than 0.1%): Hematuria, renal vasculitis
Frequency not reported: Nephrotic syndrome, glomerulonephritis, Goodpasture's syndrome[Ref]


Rare (less than 0.1%): Polymyositis, dermatomyositis
Frequency not reported: Lupus erythematosus, myasthenia gravis, rheumatoid arthritis, septic arthritis (in patients with rheumatoid arthritis), muscular weakness[Ref]


Common (1% to 10%): Rash (early and/or later in therapy), pruritus
Rare (less than 0.1%): Alopecia, pseudoxanthoma elasticum, elastosis perforans, skin laxity, lichen planus
Frequency not reported: Urticaria, epidermolysis bullosa, exfoliative dermatitis, dermopathy, dermatomyositis, pemphigus, Stevens-Johnson syndrome[Ref]


Rare (less than 0.1%): Bronchial asthma
Frequency not reported: Pulmonary hemorrhage, dyspnea, pleural effusion, alveolitis, pulmonary fibrosis, bronchiolitis, pneumonitis[Ref]


Frequency not reported: Deafness, fever, the chelating action of the drug may cause increased excretion of other heavy metals (in addition to copper) such as zinc, mercury, and lead[Ref]


Rare (less than 0.1%): Breast enlargement[Ref]


Rare (less than 0.1%): Intrahepatic cholestasis, toxic hepatitis
Frequency not reported: Cholestatic jaundice, hepatic dysfunction, pancreatitis, increased serum alkaline phosphatase, increased lactic dehydrogenase, positive cephalin flocculation test, positive thymol turbidity test[Ref]


Frequency not reported: Abnormal vision, optic neuritis[Ref]


Rare (less than 0.1%): Thrombophlebitis[Ref]


Very rare (less than 0.01%): Thyroiditis[Ref]


Both the frequency and severity of many side effects are dose related and vary according to the disease being treated. Initiating therapy at lower doses and titrating up helps to attenuate some side effects.[Ref]


Rare (less than 0.1%): Allergic reactions including hypersensitivity[Ref]


Frequency not reported: Confusion[Ref]


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

2. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0

3. Cerner Multum, Inc. "Australian Product Information." O 0

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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