Penicillamine : Uses, Side Effects, Interactions, Pictures

Penicillamine is a drug for treating rheumatoid arthritis, Wilson’s disease (a condition where copper levels in the body are high which cause damage to the liver, brain, and other organs), and certain disorders that cause kidney stones (cystinuria).

For the treatment of rheumatoid arthritis, penicillamine is known as a disease-modifying antirheumatic drug (DMARD). This drug helps to reduce pain / pain / swelling in the joints.

For the treatment of Wilson’s disease, penicillamine binds to copper and helps remove it from the body. Decreased copper levels help to improve liver function and restore mental / mood / nervous problems (eg confusion, difficulty speaking / walking) caused by illness.

For the treatment of cystinuria, penicillamine helps reduce the amount of certain substances (cystine) in urine that can cause kidney stones.

OTHER USES: This section contains uses for this drug that are not listed on the drug label that is approved by a health professional, but may be prescribed by your health care professional. Use this medicine for the conditions listed in this section if it has only been prescribed by your health care professional.

This medicine can also be used to treat lead poisoning.

What are the rules for using Penicillamine?

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

The dosage is based on your medical condition and response to treatment.

Use this medication regularly to get its benefits. To help you remember, use it at the same time every day.

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

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

For the treatment of Wilson’s disease, follow the diet recommended by your doctor to get optimum benefits. Your condition may not recover for 1 to 3 months and it can actually get worse when you start using this medicine. Tell your doctor right away if your condition continues to deteriorate after a month of treatment.

For cystinuria treatment, follow a diet recommended by your doctor to get the benefits of this drug. Drink lots of water while taking this medicine unless your doctor directs you otherwise.

Tell your doctor if your condition does not improve or gets worse.

Follow the rules given by your doctor or pharmacist before starting treatment. If you have questions, consult your doctor or pharmacist.

How to store Penicillamine?

This drug is best stored at room temperature, away from direct light and damp places. Do not store in the bathroom. Don’t freeze it. Other brands of this drug may have different storage rules. Observe the storage instructions on the product packaging or ask your pharmacist. Keep all medicines out of the reach of children and pets.                            

Do not flush medicine in the toilet or in the sewer unless instructed. Discard this product when it has expired or if it is no longer needed. Consult your pharmacist or local waste disposal company about how to safely dispose of your product.

Prevention & Warnings

What must be considered before using the drug Penicillamine?

In deciding to use this drug, the risks of using the drug must be weighed against its benefits. This is the decision of you and your doctor. For this drug, the following should be considered:

Allergy

Tell your doctor if you have ever had an unusual or allergic reaction to this or other medication. Also let your health care professional know if you have other types of allergies, such as food, coloring, preservatives, or animals. For non-prescription products, read the label or the ingredients list carefully.

Kids

Although there is no specific information about the use of penicillamine in children, it is not expected to cause different side effects or problems in children than in adults.

Parents

This drug has been tested in a number of elderly patients aged 65 years or older. In clinical trials, the elderly may have the opportunity to experience a skin rash.

Is Penicillamine safe for pregnant and lactating women?

There is no adequate research on the risks of using this drug in pregnant or nursing women. Always consult your doctor to consider the potential benefits and risks before using this medicine. This drug is included in the risk of pregnancy category D according to the US Food and Drugs Administration (FDA). (A = No risk, B = No risk in several studies, C = Possible risk, D = There is positive evidence of risk, X = Contraindications, N = Unknown)

Side effects

What penicillamine side effects might occur?

If you experience any of these serious side effects, get emergency medical help or contact your doctor right away:

  • Allergic reactions (shortness of breath; blockage of your throat, difficulty in breathing, swelling of the lips, face, or tongue, or itching)
  • Fever or chills
  • sore throat;
  • Unusual bleeding or bruising
  • Blood in urine
  • Shortness of breath for no reason, cough, or sneeze
  • Stomach ache
  • Yellow skin or eyes
  • Muscle weakness
  • Double vision

Other side effects that are less serious are more likely to occur. Continue to use penicillamine and tell your doctor if you experience it

  • Itching or rash
  • Nausea, vomiting, diarrhea, or decreased appetite
  • Ears ringing (tinnitus)
  • Decreased sense of taste (immune to taste)
  • Mouth ulcer
  • Slow wound healing
  • Increased wrinkles on the skin

Not everyone experiences the following side effects. There may be some side effects not mentioned above. If you have concerns about certain side effects, consult your doctor or pharmacist.

Drug Interactions

What medicines can interfere with the work of Penicillamine drugs?

Drug interactions can change the performance of your medication or increase the risk of serious side effects. Not all possible drug interactions are listed in this document. Keep a list of all the products you use (including prescription / nonprescription medicines and herbal products) and consult your doctor or pharmacist. Do not start, stop or change the dose of any drug without the doctor’s approval

Using this drug with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medicine or change some of the other medicines that you take.

  • Aurothioglucose

Using this drug with one of the following medicines is usually not recommended, but may be needed in some cases. If the two drugs are prescribed together, your doctor can change the dose or adjust how often you use one or both drugs.

  • Auranofin
  • Gold Sodium Thiomalate

Using this drug with one of the following medicines can cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If the two drugs are prescribed together, your doctor can change the dose or adjust how often you use one or both drugs.

  • Iron

Can certain foods and drinks interfere with the action of Penicillamine?

Certain medicines should not be used when eating or when eating certain foods because drug interactions can occur. Consuming alcohol or tobacco with certain drugs can also cause interactions to occur. Discuss your use of drugs with food, alcohol, or tobacco with your health care provider.

What health conditions can interfere with the performance of the Penicillamine drug?

Other health problems in your body can affect the use of this drug. Tell your doctor if you have other health problems:

  • Blood diseases caused by penicillamine treatment, or their history
  • Kidney disease or history (only for patients with rheumatoid arthritis) – the likelihood of side effects can be increased

Dose

The information provided is not a substitute for a doctor’s prescription. ALWAYS consult a doctor or pharmacist before starting treatment.

What is the dose of Penicillamine for adults?

Usual Adult Dose for Wilson Disease

Initial dose: 0.75-1.5 grams / day which results in an initial 24-hour cupriuresis, a dose of more than 2 mg should be continued for about three months.

Maintenance dose: The optimal maintenance dose can be determined by measuring urinary copper excretion and determining copper-free serum. It is rarely needed for doses exceeding 2 g / day.

The total daily dose must be divided into four equal doses. If the same four doses are not possible, give a larger portion at bedtime.

Usual Adult Dose for Cystinuria

The usual adult dose: 2 grams / day in the range 1-4 grams / day. The total daily dose must be divided into four doses. If the same four doses are not possible, give a larger portion at bedtime.

Usual Adult Dose for Rheumatoid Arthritis

Initial dose: Start with a single daily dose of 125 mg or 250 mg, which then increases at 1-3 month intervals, with 125 mg or 250 mg / day, as the patient’s response and tolerance show.

Maintenance dose: Maintenance dose must be individualized, and may require adjustment during treatment. Many patients respond satisfactorily to doses in the 500-750 mg range / day.

If there is no improvement and there are no signs of potentially serious toxicity after two to three months of treatment at a dose of 500-750 mg / day, increase from 250 mg / day at intervals of two to three months can be continued until there is a reduction, developing toxicity , and / or no recovery is seen after three to four months of treatment with 1000-1500 mg of penicillamine per day.

What is the dose of the drug Penicillamine for children?

Dosage of Ordinary Children for Wilson’s Disease

Initial dose: 0.75-1.5 grams / day which results in an initial 24-hour cupriuresis, a dose of more than 2 mg should be continued for about three months.

Maintenance dose: The optimal maintenance dose can be determined by measuring urinary copper excretion and determining copper-free serum. It is rarely needed for doses exceeding 2 g / day.

The total daily dose must be divided into four equal doses. If the same four doses are not possible, give a larger portion at bedtime.

Usual Children Dosage for cystinuria

Child’s dose: 30 mg / kg / day. The total daily dose must be divided into four doses. If the same four doses are not possible, give a larger portion at bedtime.

Usual Children Dosage for Rheumatoid Arthritis

Initial dose: Start with a single daily dose of 125 mg or 250 mg, which then increases at 1-3 month intervals, with 125 mg or 250 mg / day, as there is a response and tolerance in the patient

Maintenance dose: Maintenance dose must be individualized, and may require adjustment during treatment. Many patients respond well to doses in the 500-750 mg range / day.

If there is no improvement and there are no signs of potentially serious toxicity after two to three months, treatment with a dose of 500-750 mg / day, increasing from 250 mg / day at intervals of two to three months which can be continued until there is a reduction, development toxicity, and / or no recovery that can be seen after three to four months of treatment with 1000-1500 mg of penicillamine per day.

In what dosages and preparations is Penicillamine available?

Capsule, oral 250 mg

Tablet, oral: 250 mg

What should be done in an emergency or overdose?

In case of emergency or overdose, contact your local emergency services provider (118/119) or immediately to the nearest hospital emergency department.

What to do if you forget to take medication or forget to take medicine?

If you forget one dose of this medicine, take it as soon as possible. But when it is nearing the next dose, skip the missed dose and return to the usual dosage schedule. Do not double the dose.

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