Penicillamine (Oral)

Penicillamine is used in the treatment of various health problems, such as rheumatoid arthritis and Wilson's disease. The medication can also be used to prevent the formation of kidney stones.

Overview

In the US, penicillamine is sold under the brand names, Depen and Cuprimine. The drug is only available on a prescription from your GP and comes as tablets or capsules.

Penicillamine is used to treat certain health issues such as rheumatoid arthritis and Wilson' disease, where too much copper is present in the patient's body. The drug is also used in the prevention of kidney stones and some other health problems, as determined by your treating physician.

Reducing the levels of copper in the body can help to boost the patient's liver function and improve cognitive function. Kidney stones are caused by excess cystine in the urine, a condition called cystinuria.

Although penicillamine is extremely helpful in treating a variety of conditions, it can cause very serious side effects. You should therefore discuss its use with your GP before you start taking it.

This drug will not completely cure your health condition, but it will be effective in controlling the problems that the condition could cause.

Conditions treated

  • Wilson's disease
  • Cystinuria
  • Rheumatoid arthritis

Type of medicine

  • Tablets
  • Capsules

Side effects

In addition to the effects it is designed to achieve, penicillamine can sometimes cause a few unwanted effects in certain patients. You may not experience any side effects at all, but if you do, they may require further medical treatment.

You should ask your doctor's advice if you notice any of the following effects:

  • Yellow eyes or skin
  • Unexpected weight gain
  • Unusual tiredness or weakness
  • Unusual bruising or bleeding
  • Sores, ulcers, or white spots in the mouth or on the lips
  • Painful and/or swollen painful glands
  • Swelling of feet, face, or lower legs
  • Spitting blood
  • Fever and sore throat with or without chills
  • Hives, skin rash, or itching
  • Troubled breathing, shortness of breath, tightness in chest, or wheezing
  • Tinnitus
  • Reddening, itching, tenderness, burning, or skin peeling
  • Thick, red, or scaly skin
  • Red or irritated eyes
  • Red pinpoint spots on the skin
  • Pale stools
  • Difficult or painful urination
  • Muscle weakness
  • Pain in the lower back or side
  • Lesions on the neck, face, scalp, and/or trunk
  • Joint pains
  • General feelings of illness, discomfort, or weakness
  • Fever
  • Eye pain, changes in vision, blurred or double vision
  • Difficulty in chewing, breathing, swallowing, or talking
  • Dark urine
  • Cough or hoarseness
  • Chest pains
  • Cloudy or bloody urine
  • Black, bloody or tarry stools
  • Blisters on the skin
  • Severe abdominal or stomach pain

Some of the side effects that are caused by penicillamine disappear without the need for more treatment. These effects usually go away as your body acclimatizes to the new drug. In addition, your treating physician may be able to give you advice on how to reduce of prevent some or all of these effects. You should ask your GP for advice if any of the following effects are stubborn to clear or are causing you particular problems:

  • Stomach pain (mild)
  • Nausea or vomiting
  • Loss of appetite
  • Lessening or loss of sense of taste
  • Diarrhea

There are some side effects experienced by patients who are using penicillamine that are not noted in this guide. If you do notice anything odd, ask your GP for advice.

Dosage

General use

Because penicillamine is used to treat several different health conditions, it is important to be clear on why you are being prescribed this medication and on how you should use it. If you have any questions about using this medication, ask your doctor for more information.

For the prevention of kidney stones:

  • You should take penicillamine at least one hour before you eat or two hours afterwards so that your stomach is empty. Allow at least two hours after taking penicillamine before using any other medication.
  • Drink two full glasses of water (8 oz) when you to bed and a further two full glasses of water during the night.
  • Your doctor will tell you adopt a low-methionine diet during the course of your treatment. Be sure to follow this diet, and ask your GP if you have any concerns or questions about this.

For the treatment of rheumatoid arthritis:

  • You should take penicillamine at least one hour before you eat or two hours afterwards so that your stomach is empty. Allow at least two hours after taking penicillamine before using any other medication.
  • Patients should be aware that penicillamine can take up to three months to really have any discernible effect on your condition. Even if you do not think that the medication is not working, you must not stop taking it. Bear in mind that you need to give the drug time to become fully effective.

For the treatment of Wilson's disease:

  • You should take penicillamine at least one hour before you eat or two hours afterwards so that your stomach is empty.
  • Your doctor will tell you to adopt a diet that is low in copper during the course of your treatment. Be sure to follow this diet, and ask your GP if you have any concerns or questions about this.
  • Patients should be aware that penicillamine can take up to three months to really have any discernible effect on your condition. Even if you do not think that the medication is not working, you must not stop taking it. Bear in mind that you need to give the drug time to become fully effective.

For the treatment of lead poisoning:

  • You should take penicillamine at least two hours before you eat or three hours afterwards.

You must not stop taking your medication suddenly, as this could cause more severe side effects to occur. Always follow your GP's instructions if you are told to stop using penicillamine.

Dosage guidelines

The dose of penicillamine that you are prescribed may not be same for every patient. You must keep to the dose that you have been told to take by your GP or follow the dispensary label's instructions. Do not alter your dose if it differs from the following information; this guide is based on the average only.

The dose you are prescribed will be dependent on the potency of the drug you are given. The volume of the medication, the frequency of dosage, and the duration of your course will be influenced by the health condition that you are taking penicillamine to treat.

To treat Wilson's disease:

  • Adults and teens: Initially, take 250 mg four times daily. Your GP may increase this dose, depending on how your condition progresses. Generally, the dose will not exceed 2000 mg daily.
  • Children aged over six months: Initially, give 250 mg daily. Your GP may increase this dose, depending on how the child's condition progresses. Generally, the dose will not exceed 2000 mg daily.

To treat rheumatoid arthritis:

  • Adults: Initially, take 125 mg to 250 mg once daily. Your GP may increase this dose, depending on how your condition progresses and if any side effects are experienced. Generally, the dose will not exceed 1500 mg daily.
  • Children: The dose and use of this drug will be as per your doctor's directions.

To prevent kidney stones:

  • Adults: Initially, take 500 mg four times daily. Your GP may increase this dose, depending on how your condition progresses and your urine test results. Some patients may require a dose of up to 4000 mg daily. The dose is based on body weight.
  • Children: Initially, give 7.5 mg per kg of body weight four times daily. Your GP may increase this dose, depending on how the child'condition progresses and the results of urine tests. The dose is based on body weight.

Missed dose

If you do not take one of your prescribed doses, you must take it right away if you can. In the event that your next dose is almost due, leave one dose out and revert to your original dosage schedule. Do not take double the dose.

Interactions

Drug interactions

There are a number of drugs that must not be used together, as to do so could cause an interaction. Sometimes, it may be necessary to use different drugs at the same time, even though there may be an interaction. If this applies in your case, your GP may change the dose or frequency of one or both of the medicines. Alternatively, you may be advised of certain precautions that you can take to prevent or manage any interactions that might happen. Be sure to tell your GP if you are taking any other medicines, especially those mentioned in the remainder of this section of the guide.

It is not generally recommended to use penicillamine with any of the drugs noted below. Your doctor may change some of your drugs, change the dose of one or more of them, or decide to treat you with something other than

penicillamine:

  • Iron
  • Gold sodium thiomalate
  • Aurothioglucose
  • Auranofin

Other interactions

Some medicines should not be used when you are eating particular foodstuffs or when you are eating a meal. Similarly, consuming alcohol or using tobacco while using some medicines can also cause interactions. Discuss this aspect of your therapy with your GP before you starting using penicillamine.

Medical interactions

Some historical or pre-existing health conditions can interact with penicillamine. You must tell your GP if you have any existing health conditions, especially any of those mentioned below.

Patients should note that using penicillamine if you have a history of blood disease that has been caused by this drug the possibility of experiencing side effects may be higher.

If you suffer from rheumatoid arthritis and you have a history of kidney disease, using penicillamine could increase the possibility of side effects.

Warnings

When you decide to use a particular drug, you should first consider whether the benefits outweigh the risk of doing so. You can make this decision based on a discussion with your doctor, but the following points should also be considered.

Allergies

Be sure to tell your GP if you are allergic to penicillamine or to any other medications. Tell your doctor if you have ever suffered a bad reaction to any particular food groups, food colors, preservatives, or animal by-products.

Pediatric

There have been no studies specifically into the effects of penicillamine when used to treat children. However, it is not considered unsafe to use this medication in juveniles, as long as the dose is calculated correctly.

Geriatric

Although there is no evidence to suggest that penicillamine could present specific problems when used by elderly patients, tests show that this age group is more likely to suffer a skin rash when using this drug.

Pregnancy and breastfeeding

Penicillamine should not be used to treat women who are pregnant, as this drug can present a risk to the fetus during all trimesters. Tell your doctor if you are pregnant or likely to become so while using this medicine. During your course of treatment, use effective contraception to avoid getting pregnant.

Although there is nothing to show that penicillamine could be ingested by a nursing infant, you should bear in mind the potential dangers of breastfeeding while you are taking this medicine. Ask your midwife or GP for more information and advice on this matter and perhaps consider using an alternative feeding solution for your child until you have completed your course of treatment.

Medical complications

Throughout the course of your treatment with penicillamine you should see your GP on a regular basis. These visits will be used to check that the drug is working properly and is not causing any unwanted side effects.

If you are due to have any form of surgical procedure (including dental work), you must tell the presiding medical professional that you are taking penicillamine.

Take extra care when using your toothbrush, toothpicks, or dental floss. Ask your GP, practice nurse, or dentist for advice on other ways to clean your gums and teeth. Mention to your GP if you are intending to have any dental work carried out.

Be sure not to use iron supplements or vitamin supplements without checking with your GP first. If you are instructed to take iron or vitamin supplements, you should not use them within a couple of hours of taking penicillamine. If you take the two products within close proximity of each other, the penicillamine may not work correctly.

You must tell your GP immediately if you develop bruising, bleeding, fever, sore throat or chills, as these could all indicate that you have a serious blood disorder.

You should seek urgent medical assistance if you develop breathing problems, noisy breathing, or unexplained coughing, as these signs could indicate a serious respiratory disorder.

Storage

Keep penicillamine in a sealed container and at room temperature. Do not expose the medicine to direct heat, full sunlight, or moisture. Do not freeze the medicine.

Keep the medicine where pets and children cannot access it. If a pet eats any of your penicillamine tablets or capsules, check with your emergency vet right away.

Do not hold onto any penicillamine that has become out-of-date or is no longer required. Ask your pharmacist or GP for instructions on how to dispose of unwanted drugs.

Summary

Penicillamine is used in the treatment of a number of conditions, including Wilson'disease and cystinuria.

This medication is very effective in treating these health problems, but it can also be responsible for causing a few potentially serious side effects. It is therefore very important that you discuss your medical history fully with your GP before you begin using penicillamine. The drug can also cause interactions with a number of other drugs and with vitamin supplements that contain iron. Be sure to mention any other medication that you are taking to your GP.

Patients should note that this medicine will not provide a cure for your medical condition but it can help to alleviate the symptoms. You may have to take this drug for a long period of time in order to gain the full benefits. During this time, you will need to visit your doctor for regular check-ups and blood tests.

Penicillamine must not be used by women who are pregnant as this drug does present a danger to the unborn baby. Be sure to tell your GP if this is likely to apply to you while you are using this medication.