Urology / Nephrology

What is penicillamine?

Penicillamine is a prescription drug that is available as an oral tablet and oral capsule. It is used to decrease pain, swelling, and tenderness associated with rheumatoid arthritis.

It is also used to remove unwanted substances from the body. For people with Wilson’s disease, it removes excess copper. It is also used to remove arsenic in people with arsenic poisoning and to prevent bladder and kidney stones.

The brand names for this drug are Cuprimine and Depen. A generic version is not available.

Penicillamine comes with a boxed warning from the United States Food and Drug Administration (FDA), which says that only doctors who are familiar with this drug and its side effects should use it, because there is a risk of significant adverse effects.

Patients need to stay under the doctor’s supervision while using this drug, and a number of tests to monitor for changes will probably be necessary.

It can cause severe kidney damage, and it can affect the body’s blood-clotting function, increasing the risk of bleeding. It can also increase the risk of developing an infection.

It should only be prescribed by doctors who are trained to use it. The doctor will monitor the patient closely while using this drug to check for any problems.

Fast facts about penicillamine

  • Penicillamine is an oral medication used to treat rheumatoid arthritis, Wilson’s disease, cystinuria, and arsenic toxicity
  • Common side effects include upset stomach, itching skin or a rash, nausea, loss of taste, stomach pain, not feeling hungry, and diarrhea.
  • Lab results may show protein in the urine, low white blood cells, and low platelets.
  • It is not suitable for use during pregnancy, while trying to become pregnant, or while breastfeeding.
  • It may cause the body to lose vitamin B6, and daily supplements may be needed.
  • Those with kidney and bladder stones should drink at least 2 pints of water each day to flush the medicine through the system.

Uses: How it works

Penicillamine
Penicillamine is used to treat rheumatoid arthritis and also as a chelating agent, to remove unwanted substances from the body.

Penicillamine is used to treat joint disease, but exactly how it does this is unclear.

It treats kidney and bladder stones, known as cystinuria, by removing a protein called cystine from the body.

It works to treat Wilson’s disease by removing excess copper from the body. It also removes arsenic from the body in cases of arsenic poisoning.

Penicillamine is a chelating agent. That means it binds to certain compounds, which helps your body to remove them.


Common side effects

The most common side effects include:

  • rash or itchy skin
  • a loss of taste
  • not feeling hungry
  • vomiting
  • diarrhea
  • bleeding
  • fever
  • infection
  • ulcers or sores in the mouth
  • protein in the urine, which can cause kidney failure
  • low platelets and low white blood cells

Symptoms and signs of kidney problems may include:

  • swelling of the hands, feet, or face
  • cloudy or foamy urine

Mild side effects may disappear within a few days or a couple of weeks. If side effects are severe or do not go away, it is important to speak to a doctor.


Serious side effects

Penicillamine has been linked to some life-threatening cases of aplastic anemia, agranulocytosis, thrombocytopenia, Goodpasture’s syndrome, and myasthenia gravis.

It is important to be aware of the possible side effects of this and other medications.

If you experience any of the following serious side effects, call your doctor right away.

If your symptoms may be life-threatening or if you think you’re experiencing a medical emergency, call 9-1-1.

Allergic reaction

Itchy skin rash
An itchy skin rash can occur when using this drug. It may be the sign of an allergic reaction.

Symptoms may include:

  • rash
  • hives
  • itching
  • redness
  • chest tightness
  • fever

Infection

Symptoms may include:

People who are using this drug can reduce the risk of infection through infection control measures, such as by limiting contact with people who have an infection and washing the hands frequently.

If there are any signs of infection, such as fever, pain, chills, or a sore throat, you should inform your doctor.

Increased bleeding

Symptoms may include:

  • vomiting blood
  • blood in your stool
  • bleeding from your gums
  • bruising easily

This medication may affect the blood’s ability to clot. As a result, bleeding and bruising may happen more easily while taking it.

Liver problems

Symptoms may include:

  • dark-colored urine
  • vomiting
  • stomach pain
  • yellowing of the whites of your eyes or skin

Kidney problems

Symptoms may include:

  • inability to pass urine
  • increased body weight
  • blood in your urine

Pancreas problems

Symptoms may include:

Changes to your skin

These could be:

  • excessive skin wrinkling
  • skin that’s easily torn or rubs away

Other problems include thyroiditis, gastrointestinal problems, and bone marrow depression in some patients.


Food and drug interactions

Penicillamine can interact with other medications, herbs, vitamins, and other supplements, so it is important to talk to the doctor about any existing medications.

Having all prescriptions filled at the same pharmacy can help reduce this risk, because the pharmacist can check for possible drug interactions.

Food Interactions

Food can decrease the effect of this medication.

Penicillamine should be taken on an empty stomach. It can be taken 1 hour before or 2 hours after eating.

Some people may have to drink a lot of liquids while taking this medication to maximize the effect. The doctor can advise about this.

Vitamin B6

Using this drug may cause the body to excrete more vitamin B6 than usual. To prevent a deficiency, the doctor may recommend using supplements.

Drug interactions

It needs to be taken at least 1 hour before or after any other medication in order to prevent an interaction.

Here are some of the possible drug interactions.

Heart drugs: Digoxin

Penicillamine can cause lower levels of digoxin in your body and reduce its effect. A higher dose of digoxin may be necessary.

Antacids: Aluminum hydroxide and magnesium hydroxide (milk of magnesia)

Antacids can decrease the effect of penicillamine in the body. They should be avoided for one hour before and after taking penicillamine.

Iron pills

These may decrease the effect of penicillamine. Iron pills should not be taken for one hour before or after taking penicillamine.

Malaria drugs

Combining penicillamine with malaria drugs can cause serious side effects.

Cancer drugs

Serious adverse effects can result from taking penicillamine with cancer drugs.

Who should not use penicillamine?

Some people should not use this drug because the side effects can be more severe with certain conditions.

Blood cell disorders

If the body is not making enough white blood cells, penicillamine can make this worse, leading to infections and other serious side effects.

The doctor may need to do routine blood tests to monitor the patient’s blood cell counts.

Kidney disease

People with moderate or severe kidney disease should not use this drug.

Penicillamine is removed from your body by your kidneys. Kidney disease may lead to an increased amount of penicillamine in your body. This could cause increased side effects.

Pregnancy

Penicillamine is a category D pregnancy drug.

This means:

1. Studies show a risk of adverse effects to the fetus when the mother takes the drug.

2. This drug should only be used during pregnancy in serious cases where it’s needed to treat a dangerous condition in the mother.

Patients should tell the doctor if they are pregnant, plan to become pregnant, miss a period, or have unprotected sex while taking this medication.

Penicillamine can cause harm to a developing fetus.

Breast-feeding

Penicillamine may pass through breast milk and cause harm to the baby during breast-feeding. Breastfeeding is not recommended while taking penicillamine.

Children

For rheumatoid arthritis and Wilson’s disease, the safety and effectiveness of penicillamine have not been established in people younger than 18 years.

Allergies

Penicillamine can cause a severe allergic reaction in some people. Anyone who has ever had a serious reaction to this drug should not take it again. Doing so could be fatal.


Dosage

The doctor will decide on the best dose and form of the drug.

This will depend on:

  • the person’s age
  • the condition being treated
  • how severe the condition is
  • other medical conditions
  • reaction to the first dose

An adult with Wilson’s disease will probably take between 250 milligrams (mg) and 2,000 mg a day, by capsule.

For cystinuria, the usual adult dose is 2,000 mg per day, but the dose can range from 1,000 to 4,000 mg.

For rheumatoid arthritis, the doctor may prescribe between 125 mg and 1,500 mg per day.

It is important to follow the doctor’s instructions when taking any medication. If side effects occur, these should be reported to the doctor, who can advise on the next step.

Taking too much of this drug can lead to serious side effects, including nausea and vomiting, and possibly liver or kidney problems. If you miss a dose, do not take a double dose next time.

You may be able to tell the drug is working if you experience a reduction in your symptoms. Talk to your doctor to see if your medication is working for you.

This medication may be taken long term or short term. Talk to your doctor about how long you’ll need to take it.

Other tips

Here are some other points to bear in mind.

Travel

When traveling with your medication:

  • Always take it with you or in your carry-on bag
  • Note that airport X-ray machines will not affect this medication
  • You may need to show your pharmacy’s preprinted label to identify the medication.
  • Keep the original prescription-labeled box with you when traveling.

Clinical monitoring

Your doctor may do these tests to ensure the patient stays in good health while using this medication.

  • urine and blood tests for blood and kidney function
  • skin checks may be done twice a week for the first month and then every 2 weeks for the next 5 months
  • liver function tests may be done at least every 6 months while using this drug

Additional lab tests may be done to check for any side effects and to assess how well the drug is working

Alternative drugs may be available. If the side effects are problematic, the doctor can advise on what to do.

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