Penicillamine

Penicillamine is a prescription medication used for the treatment of Wilson’s disease, rheumatoid arthritis, and for treating arsenic or lead poisoning.

• Penicillamine is available under the following different brand names: Cuprimine, Depen

Adult and pediatric dosage

Tablet

• 250mg

Capsule

• 125mg
• 250mg

Wilson's Disease

Adult dosage

• 250 mg orally four times a day; dosage range 500-1500 mg/day
• Pregnancy: Not to exceed 500-750 mg/day
• Planned cesarean section: Reduce dose to 250 mg/day for the last 6 weeks of pregnancy and postoperatively until wound healing completed

Pediatric dosage

• 20 mg/kg/day orally divided every 12 hours

Arsenic Poisoning

Adult dosage

• 100 mg/kg/day orally divided every 6 hours for 5 days

Rheumatoid arthritis

Adult dosage

• Initial: 125-250 mg/day orally
• Maintenance: May be increased by 125-250 mg/day every 1-3 months up to 500-750 mg/day, may be increased further if no response and the patient tolerates

Pediatric dosage

• 1st step (2 months): 5 mg/kg orally every day for 2 months  
• 2nd step (4 months): 10 mg/kg orally every day for 4 months

Lead Poisoning

Adult dosage

• 1-1.5 g every day orally or divided twice daily or thrice daily  for 1-6 months

Pediatric dosage

• 20-40 mg/kg/day orally divided every 8 hours

Cystinuria

Pediatric dosage

• 30 mg/kg/day orally divided twice daily or four times a day; not to exceed 1 g/day

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

Common side effects of the Penicillamine include:

• decreased sense of taste,
• skin changes (wrinkling or pimples),
• stomach pain,
• nausea,
• vomiting,
• diarrhea,
• loss of appetite,
• numbness or tingly feeling,
• ringing in the ears, and
• wounds that will not heal.

Serious side effects of the Penicillamine include:

• hives,
• difficulty breathing,
• swelling of the face, lips, tongue, or throat,
• rash,
• swollen glands,
• new or worsening joint pain,
• muscle weakness in the arms and legs,
• muscle weakness in the face,
• drooping eyelids,
• trouble vision,
• trouble chewing,
• new or worsening cough,
• fever,
• blisters or ulcers in the mouth,
• red or swollen gums,
• trouble swallowing,
• peeling skin,
• watery blisters,
• pain or burning while urinating,
• foamy or bloody urine,
• lower back pain,
• swelling in the hands, legs, and feet,
• chills,
• tiredness,
• skin sores,
• easy bruising,
• unusual bleeding,
• pale skin,
• cold hands and feet,
• lightheadedness, and
• shortness of breath.

Rare side effects of the Penicillamine include:

• none 

This is not a complete list of side effects and other serious side effects or health problems that may occur as a result of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Penicillamine has severe interactions with no other drugs.
• Penicillamine has serious interactions with the following drugs:
  • gold sodium thiomalate
• sodium sulfate/potassium sulfate/magnesium sulfate
• Penicillamine has moderate interactions with at least 28 other drugs.
• Penicillamine has minor interactions with the following drugs:
  • digoxin
  • pyridoxine
  • pyridoxine (Antidote)

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist about all the products you use. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions or concerns.

Contraindications

• Penicillin allergy, discontinue if immune reactions
• History of penicillamine-related aplastic anemia, agranulocytosis
• Renal insufficiency (avoid if CrCl is less than 50 mL/min)
• Concurrency with gold salts, antimalarials, immunosuppressants, phenylbutazone

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Penicillamine?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Penicillamine?”

Cautions

• Antacids, digoxin, and iron (PO) decreased levels and/or activity
• Reactive airway disease
• Associated with obliterative bronchiolitis
• Increases the body's requirement for pyridoxine
• Potential for development of (reversible) myasthenia gravis and other neurologic symptoms.

Pregnancy and Lactation

• Use in LIFE-THREATENING emergencies when no safer drug available; allowed only in Wilson's: not to exceed 750 mg/d; contraindicated for rheumatoid arthritis and cystinuria
• Lactation
  • Little information is available, mfr states do not nurse