penicillamine, Cuprimine, Depen

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    Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

  • Medical and Pharmacy Editor: Jay W. Marks, MD
    Jay W. Marks, MD

    Jay W. Marks, MD

    Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

  • Medical and Pharmacy Editor: Charles Patrick Davis, MD, PhD
    Charles Patrick Davis, MD, PhD

    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

Symptoms of Rheumatoid Arthritis

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 brand names are available for penicillamine?

Cuprimine, Depen

Is penicillamine available as a generic drug?

GENERIC AVAILABLE: Yes, in other countries

Do I need a prescription for penicillamine?

Yes

What are the side effects of penicillamine?

Common reactions to penicillamine include: 

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.

Quick GuideLyme Disease Symptoms, Rash, Treatments

Lyme Disease Symptoms, Rash, Treatments

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).

Medically reviewed by John P. Cunha, DO, FACOEP

REFERENCES:

FDA Prescribing Information

Medscape. penicillamine (Rx) - Cuprimine, Depen.

Quick GuideLyme Disease Symptoms, Rash, Treatments

Lyme Disease Symptoms, Rash, Treatments

Summary

Penicillamine (Cuprimine, Depen) is an antirheumatic drug prescribed for the treatment of:

Side effects, drug interactions, warnings and precautions, and patient information should be reviewed prior to taking any medication.

Treatment & Diagnosis

Medications & Supplements

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Reviewed on 5/15/2017
References
Medically reviewed by John P. Cunha, DO, FACOEP

REFERENCES:

FDA Prescribing Information

Medscape. penicillamine (Rx) - Cuprimine, Depen.

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