Penicillamine

Indications & Dose:

Adult

• Wilson’s diseases: PO 250 mg tid-qid, maximum 2 g/day

• Rheumatoid arthritis: PO 125-250 mg/day, increase 250 mg q2-3 mo prn, max 1 g/day; doses > 500 mg/d should be administered in divideddoses

• Cystinuria: PO 250 mg qid ac, not to exceed 5 g/ day
Child 

Chelating agent and cystinuria: PO 20-30 mg/ kg/day in divided doses qid ac. 

Contraindications:

Penicillamine-related aplastic anemia or agranulocytosis; severe renal disease; pregnancy (except Wilson’s disease or certain cases of cystinuria) 

Side Effects:

CV: Hypotension, tachycardia
EENT: Optic neuritis, tinnitus
GI: Abdominal cramping, anorexia, diarrhoea, hepatotoxicity, nausea, pain, pancreatitis, peptic ulcer, vomiting
GU: Glomerulonephritis, nephrotic syndrome, proteinuria
HEME: Aplastic anemia, eosinophilia, granulocytopenia, hemolytic anemia, increased sedimentation rate, leukopenia, lupus syndrome, thrombocytopenia
MS: Arthralgia
RESP: Asthma, pneumonitis, pulmonary fibrosis
SKIN: Alopecia, ecchymosis, erythema, fever, pruritus, urticaria 

Cautions:

Precautions:

 Renal insufficiency 

Interaction:

Drugs
• Antacids: Magnesium-aluminium hydroxides reduce bioavailability

• Digoxin: Reduced digoxin concentrations

• Iron: Oral iron substantially reduces plasma penicillamine concentration, with reduced therapeutic response 

Warnings:

Adverse Effects:

Lactations:

Pregnancy category D (continued therapy in Wilson’s disease and cystinuria probably OK, not rheumatoid arthritis) 

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: