Detailed Drug Information:

DRUG CLASS AND MECHANISM: Penicillamine is an antirheumatic drugused to treat patients with active rheumatoid arthritis. It is alsoclassified as a metal binding (or "chelating"), agent used inthe treatment of Wilson's disease, a genetic disease that results inexcessive copper deposits in the body tissues.

PRESCRIPTION: yes

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

STORAGE: Store at room temperature, sealed container, avoidmoisture.

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

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

DRUG INTERACTIONS: Patients who are allergic to penicillin maytheoretically have a sensitivity to penicillamine, but this is not common.Penicillamine can increase the requirement for vitamin B6 (pyridoxine) andsupplementation is advised. Penicillamine should not be taken by patientswho 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 bodytissues. Therefore, it is advised to reduce the dose when surgery isconsidered and resume full dose after the wound has healed.

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

PREGNANCY: Penicillamine should not be taken by pregnant womenwith rheumatoid arthritis. Women with rheumatoid arthritis in whompregnancy 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 canbe associated with itching, which can often be controlled by simply addingantihistamine medication. Rashes associated with fever and joint painusually require discontinuing penicillamine. It can also cause loss ofappetite, nausea, abdominal pain, and loss of the sense of taste.

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

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