Generic Name: Penicillamine Brand Name(s): Generics only. No brands available.

Uses

What is Penicillamine used for?

Penicillamine 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.

How should I take 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 right away 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.

How do I store Penicillamine?

Penicillamine is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store Penicillamine in the bathroom or the freezer. There may be different brands of Penicillamine that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush Penicillamine down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using Penicillamine?

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.

Is it safe during pregnancy or breast-feeding?

There are no adequate studies in women for determining risk when using this Penicillamine during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking Penicillamine. Penicillamine is pregnancy risk category D according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

  • A=No risk,
  • B=No risk in some studies,
  • C=There may be some risk,
  • D=Positive evidence of risk,
  • X=Contraindicated,
  • N=Unknown

Side effects

What side effects can occur from Penicillamine?

Stomach/abdominal pain, nausea/vomiting, loss of appetite, diarrhea, and decreased sense of taste may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if any of these unlikely but serious side effects occur: signs of infection (such as fever, persistent sore throat, swollen lymph nodes), easy bruising/bleeding, unusual tiredness, rapid breathing, skin blisters, mouth sores, new or worsening joint pain, thinning/wrinkling skin.

Tell your doctor right away if any of these rare but serioussigns of kidney problems (such as change in the amount of urine, bloody urine), coughing up blood, shortness of breath, muscle weakness, eye problems (such as drooping eyelids, blurred vision), persistent nausea/vomiting, severe stomach/abdominal pain, dark urine, yellowing eyes/skin.

A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.

Interactions

What drugs may interact with Penicillamine?

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).

Penicillamine may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Does food or alcohol interact with Penicillamine?

Penicillamine may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with Penicillamine?

Penicillamine may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.

Dosage

The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using this Penicillamine.

What is the dose of Penicillamine for an adult?

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

Dose Adjustments

Wilson’s disease:

-In patients who cannot tolerate as much as 1 g per day initially, initiating dosage with 250 mg/day, and increasing gradually to the requisite amount, gives closer control of the effects of the drug and may help to reduce the incidence of adverse reactions.

Cystinuria:

-Initiating dosage with 250 mg per day, and increasing gradually to the requisite amount, gives closer control of the effects of the drug and may help to reduce the incidence of adverse reactions.

-If adverse reactions necessitate a reduction in dosage, it is important to retain the bedtime dose.

Other Comments

PENICILLIN ALLERGY:

-Patients who are allergic to penicillin may theoretically have cross-sensitivity to this drug. The possibility of reactions from contamination of this drug by trace amounts of penicillin has been eliminated now that this drug is being produced synthetically rather than as a degradation product of penicillin.

Administration advice:

-This drug should be administered on an empty stomach, 1 hour before or 2 hours after a meal.

What is the dose of Penicillamine for a child?

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

Precautions

Safety and efficacy have not been established in patients younger than 18 years for juvenile rheumatoid arthritis.

How is Penicillamine available?

Penicillamine is available in the following dosage forms and strengths:

  • Oral capsule,
  • Oral tablet.

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

What should I do if I miss a dose?

If you miss a dose of Penicillamine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

 

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: April 11, 2018 | Last Modified: April 11, 2018

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