Penicillamine

Antidote · Chelating agent

Indications

Cystinuria, Wilson's disease, lead poisoning, chronic active hepatitis.

Dosage

Adults: Cystinuria: Treatment, 1-3 gm daily in divided doses before food, adjusted to maintain urinary cystine below 200 mg/L; Prophylaxis to maintain urinary cystine below 300 mg/L, 0.5-1gm at bedtime. Wilson's disease: 1.5 - 2 gm daily in divided doses before food; max 2 gm daily for 1 yr. Maintenance. 0.75-1 gm daily. Lead poisoning: Hepatitis: Refer to SPC. Elderly: Wilson's disease: 20 mg/kg daily in divided doses, minimum 500 mg daily. Children: Wilson's disease: Up to 20 mg/kg daily in divided doses; minimum 500 mg daily. Elderly and Children: Cystinuria: Use minimum dose to maintain urinary cystine below 200 mg/L.

Adverse Effects

Nausea, anorexia, fever, rash, thrombocytopenia (withdraw), proteinuria. Reports of dysgeusia, haematuria (withdraw), leucopenia (withdraw), delayed rash, breast enlargement.

Risk Factor (Pregnancy/Lactation)

Contraindications: Moderate to severe renal impairment, lupus erythematosus. Agranulocytosis, aplastic anaemia or thrombocytopenia due to penicillamine. Precautions: Monitor blood, urine and renal function before and frequently during treatment, especially in the elderly. Risk of deterioration of neurological symptoms in Wilson's disease. Consider need for pyridoxine during long-term treatment. Intolerant of gold. Renal insufficiency. Pregnancy, lactation.

Interactions

Gold salts, NSAIDs or other nephrotoxic drugs, iron salts, zinc, antacids, digoxin, clozapine.

Pharmacokinetics

Absorption: Rapidly but incompletely (40%-70%). Metabolism: Hepatic. Half-life elimination: 1 hr. Time to peak, plasma: 1-3 hrs. Excretion: Renal (mainly).

Brands with this active ingredient

• Heptalamine
• Penicillamine
• Vistamin

Compiled by Healify Pharmacy from published drug references. How we compile it →

Always consult a pharmacist or doctor.