- Rheumatoid Arthritis Slideshow Pictures
- Joint-Friendly Exercises to Reduce RA Pain Slideshow
- Take the RA Quiz
- What is penicillamine, and how does it work (mechanism of action)?
- What brand names are available for penicillamine?
- Is penicillamine available as a generic drug?
- Do I need a prescription for penicillamine?
- What are the side effects of penicillamine?
- What is the dosage for penicillamine?
- Which drugs or supplements interact with penicillamine?
- Is penicillamine safe to take if I'm pregnant or breastfeeding?
- What else should I know about penicillamine?
What is penicillamine, and how does it work (mechanism of action)?
Penicillamine is an anti-rheumatic 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 compound that forms as part of scar tissue that result from inflammation.) Penicillamine also may result in 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 non-rheumatic diseases including Wilson's disease. The FDA approved penicillamine in December 1970.
What are the side effects of penicillamine?
Common reactions to penicillamine include:
- abdominal pain,
- allergic reactions,
- weight loss,
- dysgeusia (loss of sense of taste),
- lip swelling,
- itching, and
Penicillamine can cause bone marrow suppression (anemia, low blood platelets [thrombocytopenia] and white blood cells [neutropenia]) and serious kidney disease. All patients who take penicillamine require regular blood and urine testing to monitor for these side effects.
Penicillamine can increase the requirement for vitamin B6 (pyridoxine), and supplements of pyridoxine are advised. Penicillamine has an unusual risk of inducing immune-related diseases, such as systemic lupus erythematosus, polymyositis, Goodpasture's syndrome, and myasthenia gravis.
What is the dosage for penicillamine?
- Penicillamine should be taken on an empty stomach, at least one hour before meals or two hours after meals 1-4 times daily. It is usually given with 10-25 mg/day pyridoxine (Vitamin B6).
- The usual adult dose for treating rheumatoid arthritis is 125 to 250 mg daily. It may be increased by 125 to 250 mg a day every 1 to 3 months up to 500 to 750 mg daily or more if tolerated.
- Wilson's disease is treated with 250 mg 4 times daily. The dose range is 500 to 1500 mg daily.
- Cystinuria is treated with 1-4 g daily in 4 doses.
- Lead poisoning is treated with 1 – 1.5 g/day total orally. The total dose can be divided into twice or three times per day dosing; consult with a toxicologist for dosing and length of time to give medication
- Pediatric dosing: Dosing is age/weight based and a specialist (pediatric) should be consulted before dosing.
Which drugs or supplements interact with penicillamine?
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.
Is penicillamine safe to take if I'm pregnant or breastfeeding?
Penicillamine should not be used by nursing mothers because of potential adverse effects in the infant.
What else should I know about penicillamine?
What preparations of penicillamine are available?
Capsules: 125 and 250 mg; Tablets: 250 mg.
How should I keep penicillamine stored?
Penicillamine should be stored at room temperature, 15 C to 30 C (59 F to 86 F).
Penicillamine (Cuprimine, Depen) is an antirheumatic drug prescribed for the treatment of:
- rheumatoid arthritis,
- Wilson's disease,
- lead poisoning, and
- the prevention of kidney stones in patients with cystinuria.
Multimedia: Slideshows, Images & Quizzes
Rheumatoid Arthritis Quiz: What is Rheumatoid Arthritis?
How is rheumatoid arthritis different from other forms of arthritis, such as osteoarthritis and gout? Take the Rheumatoid...
Rheumatoid Arthritis (RA) Symptoms & Treatment
What is rheumatoid arthritis (RA)? Learn about juvenile rheumatoid arthritis. Discover rheumatoid arthritis (RA) symptoms,...
Rheumatoid Arthritis (RA) Exercises Slideshow: Joint-Friendly Fitness Routines
Regular exercise boosts fitness and helps reverse joint stiffness for people with rheumatoid arthritis (RA). Our experts offer...
Related Disease Conditions
Eosinophilic Fasciitis (Shulman's Syndrome)
Eosinophilic fasciitis is a skin disease that causes thickening and inflammation of the skin and fascia. Symptoms include...
Kidney Stones (nephrolithiasis)
Kidney stones are solid masses of crystalline material that form in the kidneys. Symptoms of kidney stones can include pain,...
Rheumatoid Arthritis (RA)
Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints,...
Scleroderma is an autoimmune disease of the connective tissue. It is characterized by the formation of scar tissue (fibrosis) in...
Lupus (Systemic Lupus Erythematosus or SLE)
Systemic lupus erythematosus is a condition characterized by chronic inflammation of body tissues caused by autoimmune disease....
Still's disease (systemic-onset juvenile rheumatoid arthritis) is a disorder characterized by inflammation with high fever...
Felty's syndrome is a complication of long-term rheumatoid arthritis. Felty's syndrome is defined by the presence of three...
Pulmonary fibrosis is scarring throughout the lungs. Pulmonary fibrosis can be caused by many conditions including chronic...
Cystinuria is a common genetic condition that causes excess buildup of the cystine protein in the urine. Cystinuria leads to the...
Relapsing polychondritis is an uncommon, chronic disorder of the cartilage that is characterized by recurrent episodes of...
Chronic pain is pain (an unpleasant sense of discomfort) that persists or progresses over a long period of time. In contrast to...
The definition of a genetic disease is a disorder or condition caused by abnormalities in a person's genome. Some types of...
Lead-based paint and lead contaminated dust are the main sources of exposure for lead in U.S. children. Lead-based paints were...
Treatment & Diagnosis
- Rheumatoid Arthritis FAQs
- Drugs: Buying Prescription Drugs Online Safely
- Drugs: The Most Common Medication Errors
- How To Reduce Your Medication Costs
- Pharmacy Visit, How To Get The Most Out of Your Visit
- Indications for Drugs: Approved vs. Non-approved
- Medication Disposal
- Dangers of Mixing Medications
- Generic Drugs, Are They as Good as Brand-Names?
- Antibiotics 101 - Audio Podcast
Medications & Supplements
Health Solutions From Our Sponsors
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.
FDA Prescribing Information
Medscape. penicillamine (Rx) - Cuprimine, Depen.