PENICILLAMINE

Brand & Generic Names

Cuprimine
Depen

Basic Information

• Habit forming? No
• Prescription needed? Yes
• Available as generic? No
• Drug class: Chelating agent, antirheumatic, antidote (heavy metal)

Uses

• Treatment for rheumatoid arthritis.
• Prevention of kidney stones.
• Treatment for heavy metal poisoning.

Dosage & Usage Information

How to take:
Tablets or capsules--With liquid on an empty stomach 1 hour before or 2 hours after eating.

When to take:
At the same times each day.

If you forget a dose:
1 dose a day--Take as soon as you remember up to 12 hours late. If more than 12 hours, wait for next scheduled dose (don't double this dose).
More than 1 dose a day--Take as soon as you remember up to 2 hours late. If more than 2 hours, wait for next scheduled dose (don't double this dose).

What drug does:
Combines with heavy metals so kidney can excrete them.
Combines with cysteine (amino acid found in many foods) to prevent cysteine kidney stones.
May improve protective function of some white-blood cells against rheumatoid arthritis.

Time lapse before drug works:
2 to 3 months.

Don't take with:
Any other medicine without consulting your doctor or pharmacist.

Overdose

SYMPTOMS:
Ulcers, sores, convulsions, coughing up blood, coma.

WHAT TO DO:

• Dial 911 (emergency) or O (operator) for an ambulance or medical help. Then give first aid immediately.
• See EMERGENCY Information.

Possible Adverse Reactions or Side Effects

Life-threatening:

In case of overdose, see Overdose section.

Common:

Rash, itchy skin, swollen lymph glands, appetite loss, nausea, diarrhea, vomiting, decreased taste.

Infrequent:

Sore throat, fever, unusual bruising, swollen feet or legs, bloody or cloudy urine, weight gain, fatigue, weakness, joint pain.

Rare:

Double or blurred vision; pain; ringing in ears; ulcers, sores, white spots in mouth; difficult breathing; coughing up blood; jaundice; abdominal pain; skin blisters; peeling skin.

Warnings & Precautions

Don't take if:

• You are allergic to penicillamine.
• You have severe anemia.

Before you start, consult your doctor:

• If you have kidney disease.
• If you are allergic to any pencillin antibiotic.

Over age 60:
More likely to damage blood cells and kidneys.

Pregnancy:
Risk to unborn child outweighs drug benefits. Don't use.

Breast-feeding:
Safety not established. Consult doctor.

Infants & children:
Use only under medical supervision.

Prolonged use:

• May damage blood cells, kidney, liver.
• Talk to your doctor about the need for follow-up medical examinations or laboratory studies to check complete blood counts (white blood cell count, platelet count, red blood cell count, hemoglobin, hematocrit), kidney function, liver function.

Skin & sunlight:
No problems expected.

Driving, piloting or hazardous work:
No problems expected.

Discontinuing:
No problems expected.

Others:
Request laboratory studies on blood and urine every 2 weeks. Kidney and liver function studies recommended every 6 months.

Possible Interaction with Other Drugs

GENERIC NAME	COMBINED EFFECT
------------------------	-----------------------
Clozapine	Toxic effect on bone marrow.
Flecainide	Possible decreased blood cell
	production in bone marrow.
Gold compounds*	Damage to blood cells and kidney.
Immunosuppressants*	Damage to blood cells and kidney.
Iron supplements*	Decreased effect of penicillamine.
	Wait 2 hours between doses.
Oxyphenbutazone	Damage to blood cells and kidney.
Phenylbutazone	Damage to blood cells and kidney.
Quinine	Damage to blood cells and kidney.
Tiopronin	Increased risk of toxicity to bone
	marrow and kidneys.
Tocainide	Possible decreased blood cell
	production in bone marrow.
Zinc supplements	Increased need for zinc.

Possible Interaction with Other Substances

INTERACTS WITH	COMBINED EFFECT
---------------	---------------
Alcohol:	Increased side effects of
	penicillamine.
Beverages:	None expected.
Cocaine:	Increased side effects of
	penicillamine.
Foods:	Possible decreased penicillamine
	effect by decreased absorption.
Marijuana:	Increased side effects of
	penicillamine.
Tobacco:	None expected.