Medications and Drugs
Pharmacy Author: Omudhome Ogbru, PharmD
Medical and Pharmacy Editor: Jay W. Marks, MD
GENERIC NAME: penicillamine
BRAND NAMES: Cuprimine, Depen
DRUG CLASS AND MECHANISM: Penicillamine is an antirheumatic drug used to
treat patients with active rheumatoid arthritis. It also is classified as a
metal binding (chelating) agent used for treating
Wilson's disease, a genetic
disease that causes excessive copper to accumulate in the body. The mechanism of
action of penicillamine in rheumatoid arthritis is unknown but it may be related
to reduction of collagen formation. (Collagen is a type of tissue that forms a
part of scar tissue that results from inflammation) and suppression of the
immune system. In patients with rheumatoid arthritis, penicillamine appears to
slow the progression of the disease (specifically deformities of the joints) and
improve function. For this reason it is considered a disease modifying
anti-rheumatic drug (DMARD). Penicillamine binds copper, iron, mercury, lead, and
cystine which then are excreted in the urine, and this mechanism is important in
treating several nonrheumatic diseases including Wilson's disease. The FDA
approved penicillamine in December 1970.
PRESCRIPTION: Yes
GENERIC AVAILABLE: No
PREPARATIONS: Capsules: 125 and 250 mg; Tablets: 250 mg.
STORAGE: Penicillamine should be stored at room temperature, 15 to 30 C (59
to 86 F).
PRESCRIBED FOR: Penicillamine is used to treat active rheumatoid arthritis
that has not responded to other drugs. Penicillamine also is used to promote
copper excretion from the body in patients with Wilson's disease and is useful
for preventing cystine kidney stones in individuals with cystinuria. It has been
used in the treatment of lead poisoning.
DOSING:
- Penicillamine should be taken on an empty stomach, at least one hour
before meals or two hours after meals 1-4 times daily. The usual adult dose is
125-750 mg daily. Some patients may require up to 1 g daily administered in 4
doses.
- Wilson's disease is treated with 750-1.5 g daily in 4 doses.
- Cystinuria
is treated with 1-4 g daily in 4 doses.
DRUG INTERACTIONS: Penicillamine should not be taken by patients who are also
taking gold [gold sodium
thiomalate; aurothiomalate (Myochrysine),
auranofin (Ridaura),
aurothioglucose (Solganal)], antimalarial
[hydroxychloroquine (Plaquenil)],
phenylbutazone (Butazolidine), or cytotoxic drugs
[cyclophosphamide (Cytoxan),
azathioprine (Imuran, Azasan),
methotrexate (Rheumatrex,
Trexall)]
because these drugs also affect the bone marrow and kidney and when combined
with penicillamine can seriously reduce bone marrow and kidney function.
The
absorption of penicillamine is reduced by iron (ferrous sulphate), magnesium and
aluminum salts (for example, antacids) because they form unabsorbable complexes
with penicillamine in the intestine. Administration of penicillamine and iron
containing products or antacids should be separated by 2 hours.
PREGNANCY: Penicillamine should not be taken by
pregnant women unless it is
for a life-threatening condition, because of potential harm to the fetus.
NURSING MOTHERS: Penicillamine should not be used by
nursing mothers because
of potential adverse effects in the infant.
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
- Drug Interactions - Learn about potential drug interactions you may be exposed to. Drug interactions can occur with prescription drugs, OTC medication, vitamins, herbs, and supplements.
- Rheumatoid Arthritis - Learn more about rheumatoid arthritis, an autoimmune disease that causes chronic joint inflammation, which has symptoms that include stiffness, fever, muscle and joint aches, loss of appetite, and fatigue. Treatment of rheumatoid arthritis incorporates the use of first-line drugs (aspirin and corticosteroids for pain and inflammation) and second-line drugs (methotrexate and hydroxychloroquine to prevent joint destruction and promote remission).
- Drugs: What You Should Know About Your Drugs - Find out what you should know about your drugs such as side effects, warnings and precautions, storage information, and if a generic version is as good as the brand name.
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