PENICILLAMINE

COMMON BRAND NAME(S): Cuprimine, Depen

GENERIC NAME(S): PENICILLAMINE

 

Description: Penicillamine is a chelating agent which aids the removal of heavy-metal ions including copper, lead, arsenic and mercury from the body by forming complexes that are readily excreted by the kidney.

Onset: Rheumatoid arthritis: 2-3 mth; Wilson’s disease: 1-3 mth.

Pharmacokinetics:

Absorption: 40-70%; time to peak, serum: 2-3 hr.

Distribution: Protein-binding: 80% to albumin.

Metabolism: Hepatic (small amounts).

Excretion: Elimination half-life: 1.7-3.2 hr; excretion via urine (30-60% as unchanged drug).

This medication is used to treat rheumatoid arthritis, Wilson’s disease (a condition in which high levels of copper in the body cause damage to the liver, brain, and other organs), and a certain disorder which causes kidney stones (cystinuria).

 

For the treatment of rheumatoid arthritis, penicillamine is known as a disease-modifying antirheumatic drug (DMARD). It helps to decrease pain/tenderness/swelling in the joints. For the treatment of Wilson’s disease, penicillamine binds to copper and helps it to be removed from the body. Decreasing copper levels helps to improve liver function and the mental/mood/nerve problems (such as confusion, difficulty speaking/walking) caused by the disease. For the treatment of cystinuria, penicillamine helps to decrease the amount of a certain substance (cystine) in the urine which can cause kidney stones.

 

OTHER USES:

This drug may also be used to treat lead poisoning.

 

How to use penicillamine

Take this medication by mouth on an empty stomach (1 hour before or 2 hours after meals) as directed by your doctor. Take this medication at least 1 hour apart from other drugs (especially antacids), milk, or food.

 

Dosage is based on your medical condition and response to treatment.

 

Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time(s) each day.

 

Your doctor may also direct you to take vitamin B6 (pyridoxine) and iron. Follow your doctor’s instructions carefully. If you need to take iron or other products that contain minerals (such as zinc), take it at least 2 hours before or after taking penicillamine. Consult your doctor before taking any products containing minerals since they may block the absorption of penicillamine.

 

For the treatment of rheumatoid arthritis, it may take 2 to 3 months before you see any improvement in your condition.

 

For the treatment of Wilson’s disease, follow the diet recommended by your doctor to get the most benefit from this medication. Your condition may not improve for 1 to 3 months and may actually get worse when you start this medication. Tell your doctor immediately if your condition continues to worsen after a month of treatment.

 

For the treatment of cystinuria, follow the diet recommended by your doctor to get the most benefit from this medication. Drink plenty of water unless your doctor directs you otherwise.

 

Tell your doctor if your condition does not improve or if it worsens.

Pregnancy Risk: Category D (Positive evidence for risk)

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

Rare

  • 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

Some penicillamine side effects may not need any medical attention:

More common

  • Diarrhea
  • lessening or loss of sense of taste
  • loss of appetite
  • nausea or vomiting

stomach pain (mild)

Precautions:

 

Before taking penicillamine, tell your doctor or pharmacist if you are allergic to it; or to penicillins; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

 

Before using this medication, tell your doctor or pharmacist your medical history, especially of: a previous severe reaction to penicillamine (such as aplastic anemia, agranulocytosis), kidney disease, blood/bone marrow disorders (such as thrombocytopenia).

 

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

 

Penicillamine is not recommended for use during pregnancy. It may harm an unborn baby. However, it may sometimes be used during pregnancy in certain situations (such as treating Wilson’s disease). Consult your doctor for more details.

 

It is unknown if this medication passes into breast milk. Because of the possible risk to the infant, breast-feeding while using this drug is not recommended. Consult your doctor before breast-feeding.

 

Interactions:

 

See also How to Use section.

 

The effects of some drugs can change if you take other drugs or herbal products at the same time. This can increase your risk for serious side effects or may cause your medications not to work correctly. These drug interactions are possible, but do not always occur. Your doctor or pharmacist can often prevent or manage interactions by changing how you use your medications or by close monitoring.

 

To help your doctor and pharmacist give you the best care, be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products) before starting treatment with this product. While using this product, do not start, stop, or change the dosage of any other medicines you are using without your doctor’s approval.

 

Some products that may interact with this drug include: digoxin, gold salts (such as auranofin), drugs to treat malaria (such as chloroquine), phenylbutazone, other drugs that decrease bone marrow function (such as azathioprine, cancer chemotherapy, trimethoprim/sulfamethoxazole).

 

This document does not contain all possible drug interactions. Keep a list of all the products you use. Share this list with your doctor and pharmacist to lessen your risk for serious medication problems.

Overdose:

 

If overdose is suspected, contact a poison control center or emergency room immediately.

 

Notes

Do not share this medication with others.

 

Laboratory and/or medical tests (such as complete blood count, hematocrit/hemoglobin, liver function, urine test, physical exam) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

 

Missed Dose

If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

 

Storage

Store at room temperature between 59-86 degrees F (15-30 degrees C) away from light and moisture. Do not store in the bathroom. Keep all medicines away from children and pets.

 

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

 

Brands:

 

Available Brands:

Cuprimine

Depen

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