Penicillamine
Wilson's disease, cystinuria, and rheumatoid arthritis--severe active disease unresponsive to conventional therapy. Heavy metal antagonist. Investigational: Primary biliary cirrhosis. Scleroderma
Usage
Wilson's disease, cystinuria, and rheumatoid arthritis--severe active disease unresponsive to conventional therapy. Heavy metal antagonist. Investigational: Primary biliary cirrhosis. Scleroderma
Dose
- ?Capsules, Tablets Rheumatoid arthritis. Adults, individualized, initial: 125-250 mg/day. Dosage may be increased at 1- to 3-month intervals by 125- to 250-mg increments until adequate response is attained. Maximum: 500-750 mg/day. Up to 500 mg/day can be given as a single dose; higher dosages should be divided. Maintenance, individualized. Range: 500-750 mg/day. If the client is in remission for 6 or more months, a gradual stepwise decrease in dose of 125 or 250 mg/day at about 3-month intervals can be attempted. Wilson's disease. Dosage is usually calculated on the basis of the urinary excretion of copper. One gram of penicillamine promotes excretion of 2 mg of copper. Adults and adolescents, usual, initial: 250 mg q.i.d. Dosage may have to be increased to 2 g/day. A further increase does not produce additional excretion. Pediatric, 6 months--young children: 250 mg as a single dose given in fruit juice. Antidote for heavy metals. Adults: 0.5-1.5 g/day for 1-2 months; pediatric: 30-40 mg/kg/day (600-750 mg/m2/day) for 1-6 months. Cystinuria. Individualized and based on excretion rate of cystine (100-200 mg/day in clients with no history of stones, below 100 mg with clients with history of stones or pain). Initiate at low dosage (250 mg/day) and increase gradually to minimum effective dosage. Adult, usual: 2 g/day (range: 1-4 g/day); pediatric: 7.5 mg/kg q.i.d. If divided in fewer than four doses, give larger dose at night. Primary biliary cirrhosis. Adults: 600-900 mg/day.
Interaction
- Antacids / Effect of penicillamine due to absorption from GI tract Antimalarial drugs / Risk of blood dyscrasias and adverse renal effects Cytotoxic drugs / Risk of blood dyscrasias and adverse renal effects Digoxin / Penicillamine effect of digoxin Gold therapy / Risk of blood dyscrasias and adverse renal effects Iron salts / Effect of penicillamine due to absorption from GI tract
Side effects
- This drug manifests a large number of potentially serious side effects. Clients should be carefully monitored. GI: Altered taste perception (common), N&V, diarrhea, anorexia, GI pain, stomatitis, oral ulcerations, reactivation of peptic ulcer, glossitis, cheilosis, colitis, gingivostomatitis (rare). CNS: Tinnitus, myasthenia gravis, peripheral sensory and motor neuropathies (with or without muscle weakness), reversible optic neuritis, polyradiculopathy (rare). Hematologic: Thrombocytopenia, leukopenia, agranulocytosis, aplastic anemia, eosinophilia, monocytosis, red cell aplasia, thrombocytopenia, hemolytic anemia, leukocytosis, thrombocytosis. Renal: Proteinuria, hematuria, nephrotic syndrome, Goodpasture's syndrome (a severe and ultimately fatal glomerulonephritis). Allergic: Rashes (common), lupus-like syndrome, drug fever, pruritus, pemphigoid-type symptoms (e.g., bullous lesions), drug fever, arthralgia, lymphadenopathy, dermatoses, urticaria, thyroiditis, hypoglycemia, migratory polyarthralgia, polymyositis, allergic alveolitis. Respiratory: Obliterative bronchiolitis, pulmonary fibrosis, pneumonitis, bronchial asthma, interstitial pneumonitis. Dermatologic: Increased skin friability, excessive skin wrinkling, development of small white papules at venipuncture and surgical sites, alopecia or falling hair, lichen planus, dermatomyositis, nail disorders, toxic epidermal necrolysis, cutaneous macular atrophy. Hepatic: Pancreatitis, hepatic dysfunction, intrahepatic cholestasis, toxic hepatitis (rare). Other: Thrombophlebitis, hyperpyrexia, polymyositis, mammary hyperplasia, renal vasculitis (may be fatal), hot flashes, lupus erythematosus-like syndrome
Precautions
- The use of penicillamine for juvenile rheumatoid arthritis has not been established. Clients older than 65 years may be at greater risk of developing hematologic side effects
Who should not take?
- Pregnancy, lactation, penicillinase-related aplastic anemia or agranulocytosis, hypersensitivity to drug. Clients allergic to penicillin may cross-react with penicillamine. Renal insufficiency or history thereof
Concentration
- Penicillamine, 250mg/capsule
Available forms
- Capsule, box 10 capsules
Related terms
Artamine
