- Rheumatoid Arthritis Slideshow Pictures
- Take the RA Quiz
- Joint-Friendly Exercises to Reduce RA Pain Slideshow
Does Depen (penicillamine) cause side effects?
The mechanism of action of Depen in rheumatoid arthritis is unknown but it may be related to reduction of collagen formation. Depen also may result in suppression of the immune system.
In patients with rheumatoid arthritis, Depen appears to slow the progression of the disease (specifically deformities of the joints) and improve function and so it is considered a disease modifying anti-rheumatic drug (DMARD). Depen 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.
Common side effects of Depen include
- abdominal pain,
- allergic reactions,
- weight loss,
- loss of sense of taste,
- lip swelling,
- itching, and
Serious side effects of Depen include
- bone marrow suppression (anemia, low blood platelets [thrombocytopenia] and white blood cells [neutropenia]),
- serious kidney disease, and
- increased risk of inducing immune-related diseases, such as
Drug interactions of Depen include gold (gold sodium thiomalate; aurothiomalate, auranofin, aurothioglucose), antimalarials, phenylbutazone, or cytotoxic drugs, because these drugs also affect the bone marrow and kidneys and when combined with Depen can seriously reduce bone marrow and kidney function.
The absorption of Depen is reduced by iron (ferrous sulphate), magnesium and aluminum salts (for example, antacids) because they form unabsorbable complexes with Depen in the intestine.
Administration of Depen and iron-containing products or antacids should be separated by 2 hours.
Although normal outcomes have been reported, birth defects have also been reported in infants born of mothers who received therapy with Depen during pregnancy. Depen should be used in women of childbearing potential only when the expected benefits outweigh the possible hazards.
Depen should not be used by breastfeeding mothers because of potential adverse effects in the infant.
What are the important side effects and warnings of Depen (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.
Depen (penicillamine) side effects list for healthcare professionals
To report suspected adverse reactions, contact Meda Pharmaceuticals Inc. at 1-800-526-3840 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
Penicillamine is a drug with a high incidence of untoward reactions, some of which are potentially fatal. Therefore, it is mandatory that patients receiving penicillamine therapy remain under close medical supervision throughout the period of drug administration.
Reported incidences (%) for the most commonly occurring adverse reactions in rheumatoid arthritis patients are noted, based on 17 representative clinical trials reported in the literature (1270 patients).
Generalized pruritus, early and late rashes (5%), pemphigus, and drug eruptions which may be accompanied by fever, arthralgia, or lymphadenopathy have occurred. Some patients may show a lupus erythematosus-like syndrome similar to drug-induced lupus produced by other pharmacological agents.
Some patients may develop a migratory polyarthralgia, often with objective synovitis.
Isolated cases of reactivated peptic ulcer have occurred, as have hepatic dysfunction and pancreatitis. Intrahepatic cholestasis and toxic hepatitis have been reported rarely. There have been a few reports of increased serum alkaline phosphatase, lactic dehydrogenase, and positive cephalin flocculation and thymol turbidity tests.
Some patients may report a blunting, diminution, or total loss of taste perception (12%); or may develop oral ulcerations. Although rare, cheilosis, glossitis, and gingivo-stomatitis have been reported.
Gastrointestinal side effects are usually reversible following cessation of therapy.
Penicillamine can cause bone marrow depression. Leukopenia (2%) and thrombocytopenia (4%) have occurred. Fatalities have been reported as a result of thrombocytopenia, agranulocytosis, aplastic anemia, and sideroblastic anemia.
Thrombotic thrombocytopenic purpura, hemolytic anemia, red cell aplasia, monocytosis, leukocytosis, eosinophilia, and thrombocytosis have also been reported.
Patients on penicillamine therapy may develop proteinuria (6%) and/or hematuria which, in some, may progress to the development of the nephrotic syndrome as a result of an immune complex membranous glomerulopathy.
Central Nervous System
Tinnitus, optic neuritis, and peripheral sensory and motor neuropathies (including polyradiculoneuropathy, i.e., Guillain-Barre Syndrome) have been reported. Muscular weakness may or may not occur with the peripheral neuropathies.
Adverse reactions that have been reported rarely include thrombophlebitis; hyperpyrexia; falling hair or alopecia; lichen planus; polymyositis; dermatomyositis; mammary hyperplasia; elastosis perforans serpiginosa; toxic epidermal necrolysis; anetoderma (cutaneous macular atrophy); and Goodpasture's syndrome, a severe and ultimately fatal glomerulonephritis associated with intra-alveolar hemorrhage.
Fatal renal vasculitis has also been reported. Allergic alveolitis, obliterative bronchiolitis, interstitial pneumonitis, and pulmonary fibrosis have been reported in patients with severe rheumatoid arthritis, some of whom were receiving penicillamine. Bronchial asthma also has been reported.
Increased skin friability, excessive wrinkling of skin, and development of small, white papules at venipuncture and surgical sites have been reported.
The chelating action of the drug may cause increased excretion of other heavy metals such as zinc, mercury, and lead.
There have been reports associating penicillamine with leukemia. However, circumstances involved in these reports are such that a cause and effect relationship to the drug has not been established.
Depen (penicillamine) is a metal binding (chelating) agent used to treat rheumatoid arthritis and Wilson's disease, a genetic disease that causes excessive copper to accumulate in the body. Common side effects of Depen include abdominal pain, cramps, rash, allergic reactions, weight loss, diarrhea, loss of sense of taste, nausea, lip swelling, itching, and vomiting. Although normal outcomes have been reported, birth defects have also been reported in infants born of mothers who received therapy with Depen during pregnancy. Depen should not be used by breastfeeding mothers because of potential adverse effects in the infant.
Multimedia: Slideshows, Images & Quizzes
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...
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...
Famous Faces With Rheumatoid Arthritis
Learn more about the famous faces of rheumatoid arthritis such as Lucille Ball, Glenn Frey, and more.
Related Disease Conditions
Rheumatoid Arthritis (RA)
Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease. The 16 characteristic early RA signs and symptoms include the following. Anemia Both sides of the body affected (symmetric) Depression Fatigue Fever Joint deformity Joint pain Joint redness Joint stiffness Joint swelling Joint tenderness Joint warmth Limping Loss of joint function Loss of joint range of motion Many joints affected (polyarthritis)
16 Early Signs and Symptoms of Rheumatoid Arthritis (RA)
Early RA symptoms and signs vary differently from person to person. The most common body parts that are initially affected by RA include the small joints of the hands, wrists, and feet, and the knees and hip joints. Joint inflammation causes stiffness. Warmth, redness, and pain may vary in degree.
Pain Management and Rheumatoid Arthritis
Second Source article from WebMD
Second Source article from Government
Rheumatoid Arthritis vs. Fibromyalgia
Though rheumatoid arthritis (RA) and fibromyalgia have similar symptoms, RA is an autoimmune disease and fibromyalgia is a chronic pain syndrome. RA symptoms include joint redness, swelling, and pain that lasts more than six weeks. Fibromyalgia symptoms include widespread pain, tingling feet or hands, depression, and bowel irritability. Home remedies for both include stress reduction, exercise, and getting enough sleep.
Juvenile Rheumatoid Arthritis (JRA)
Juvenile rheumatoid arthritis (JRA) annually affects one child in every thousand. There are six types of JRA. Treatment of juvenile arthritis depends upon the type the child has and should focus on treating the symptoms that manifest.
What Is the Main Cause of Rheumatoid Arthritis?
Rheumatoid arthritis is a chronic inflammatory disease characterized by pain and inflammation in joints, typically of the hands and feet. It is an autoimmune disease in which the immune system of the body attacks its own healthy cells, resulting in inflammation of the membrane lining the joints and damage to joint tissue.
Osteoarthritis vs. Rheumatoid Arthritis
Osteoarthritis (OA) and rheumatoid arthritis (RA) are chronic joint disorders. RA is also an autoimmune disease. OA and RA symptoms and signs include joint pain, warmth, and tenderness. Over-the-counter pain relievers treat both diseases. There are several prescription medications that treat RA.
Rheumatoid Arthritis vs. Arthritis
Arthritis is a general term used to describe joint disease. Rheumatoid arthritis (RA) is a type of arthritis in which the body’s immune system mistakenly attacks the joints, causing chronic inflammation.
Treatment & Diagnosis
- Rheumatoid Arthritis FAQs
- What if I get COVID-19 with Rheumatoid Arthritis?
- Rheumatoid Arthritis vs. Osteoarthritis
- Rheumatoid Arthritis (RA): 17 Warning Signs of Serious Complications
- Rheumatoid Arthritis: Questions for Your Doctor
- Kineret (anakinra) for Rheumatoid Arthritis
- Treatment Update on Rheumatoid Arthritis
- Psoriasis, Lupus, Rheumatoid Arthritis Share One Gene
- Rheumatoid Arthritis & Diabetes Gene (PTPN22)
- Arava Approved For Rheumatoid Arthritis
- Smoking: A New Risk - Rheumatoid Arthritis
- Cox-2 Inhibitors, What's Next? - Expert Panel Votes
- Patient Story: Rheumatoid Arthritis Symptoms
- Rheumatoid Arthritis: Which Patients Do Best?
- 5 Surprising Facts About Rheumatoid Arthritis
- Patient Story: Rheumatoid Arthritis and Pregnancy
- Ultrasound Imaging of Joints in Rheumatoid Arthritis (RA)
- Living With Rheumatoid Arthritis
- Is Inflammatory Arthritis the Same as Rheumatoid Arthritis?
- Can Milk Allergy Cause Rheumatoid Arthritis?
- What Are the Side Effects of Remicade for Rheumatoid Arthritis?
- Should You Avoid Drinking Soda with Rheumatoid Arthrits?
- Are Hidradenitis and Rheumatoid Arthritis Related?
- Does Lipitor Help Rheumatoid Arthritis?
- Will Rheumatoid Arthritis Nodules Go Away?
- What's the Rheumatoid Arthritis Prognosis?
- What Are Home Remedies for Rheumatoid Arthritis?
- Patient Story: Rheumatoid Arthritis Treatment
- Rheumatoid Arthritis: Living With a Chronic Disease
Medications & Supplements
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.
Professional side effects and drug interactions sections courtesy of the U.S. Food and Drug Administration.