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 is also classified as a metal binding (or "chelating"), agent used in the treatment of Wilson's disease, a genetic disease that results in excessive copper deposits in the body tissues.

PRESCRIPTION: yes

GENERIC AVAILABLE: no

PREPARATIONS: (Cuprimine) Capsules: 125mg, 250mg; (Depen) Tablets: 250mg.

STORAGE: Store at room temperature, sealed container, avoid moisture.

PRESCRIBED FOR: Penicillamine is used to treat active rheumatoid arthritis that has not responded to other measures. Penicillamine is also used in the treatment of scleroderma. Penicillamine is also used to treat the genetic disease, Wilson's disease, to promote copper excretion from the body where it has deposited in the tissues. It is also helpful to treat another rare inherited disease, cystinuria, where it is used to bind cystine and prevent cystine kidney stones.

DOSING: Should be taken on an empty stomach, at least one hour before meals or two hours after meals.

DRUG INTERACTIONS: Patients who are allergic to penicillin may theoretically have a sensitivity to penicillamine, but this is not common. Penicillamine can increase the requirement for vitamin B6 (pyridoxine) and supplementation is advised. Penicillamine should not be taken by patients who are also taking gold (Myochrysine, Ridaura, Solganal), antimalarial (Plaquenil), phenylbutazone (Butazolidine), or cytotoxic drugs (Cytoxan, Imuran, Rheumatrex) because of similar bone marrow and kidney risks. Penicillamine can weaken the protein (collagen) that is used to form body tissues. Therefore, it is advised to reduce the dose when surgery is considered and resume full dose after the wound has healed.

The effectiveness of penicillamine for treating arthritis in children has not been established.

PREGNANCY: Penicillamine should not be taken by pregnant women with rheumatoid arthritis. Women with rheumatoid arthritis in whom pregnancy is suspected should discontinue penicillamine.

SIDE EFFECTS: Penicillamine can cause rashes early in treatment which usually resolve within days of discontinuing the drug. A late rash, seen after 6 months of treatment, may take weeks to disappear. Rashes can be associated with itching, which can often be controlled by simply adding antihistamine medication. Rashes associated with fever and joint pain usually require discontinuing penicillamine. It can also cause loss of appetite, nausea, abdominal pain, and loss of the sense of taste.

Penicillamine can cause bone marrow suppression and serious kidney disease. All patients who take penicillamine require regular blood and urine testing for monitoring.

Penicillamine has an unusual risk of inducing immune-related diseases, such as systemic lupus erythematosus, polymyositis, Goodpasture's syndrome and myasthenia gravis.

Last Editorial Review: 12/31/1997

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