Penicillamine
About
Penicillamine belongs to the group of medicines called ‘chelating agents’ used to treat severe rheumatoid arthritis, Wilsons disease, and cystinuria. Rheumatoid arthritis is a joint disorder in which our immune system attacks our body cells. Wilson disease is a genetic problem characterized by excess copper deposited in body parts like the eye, brain, and liver leading to metal toxicity. Cystinuria is the excess build-up of an amino acid called cystine in the urinary bladder and kidney, leading to harmful effects.
Penicillamine contains Penicillamine which works by blocking the action of certain chemical messengers responsible for inflammation and slows the progress of the condition with certain joint diseases. It works in Wilson's disease by binding to the extra copper in the body and causing it to leave the body through the urine. Decreasing copper levels improves liver function, and mental, mood, and nerve problems (like confusion, and difficulty speaking or walking) caused due to Wilson's disease. Besides this, Penicillamine is also used to treat cystinuria (kidney and bladder stone) and lead poisoning.
Take Penicillamine exactly as prescribed by your doctor. You are advised to take Penicillamine for as long as your doctor has prescribed it for you depending on your medical condition. In some cases, you may experience certain common side effects such as protein in the urine, low blood platelets, stomach upset or throwing up, diarrhoea, change in taste, loss of appetite, mouth irritation, and mouth sores. Most of these side effects do not require medical attention and will resolve gradually over time. However, you are advised to talk to your doctor if you experience these side effects persistently.
To treat your condition effectually, continue taking Penicillamine for as long as your doctor has prescribed. To avoid recurring symptoms, do not stop it midway. Do not take Penicillamine if you are pregnant or planning for pregnancy as Penicillamine causes serious congenital disabilities. Penicillamine should not be taken by breastfeeding mothers as it passes into breast milk. Your doctor may advise you to undergo regular blood tests, and kidney and liver tests to monitor your condition. Inform your doctor about your health condition and medicines to rule out any unpleasant side effects.
Uses of Penicillamine
Medicinal Benefits
Penicillamine contains Penicillamine primarily used to treat Wilson's disease (copper builds up in the body and may result in serious symptoms) and cystinuria (kidney stones). It is also used in combination with other treatments to treat severe rheumatoid arthritis. The treatment of rheumatoid arthritis Penicillamine reduces pain, inflammation, and slow joint damage and disease progression over time; hence Penicillamine is known as a disease-modifying anti-rheumatic drug (DMARD). In Wilson's disease, Penicillamine works by binding to the extra copper in the body and causing it to leave the body through the urine. Decreasing copper levels improves liver function and the mental, mood, and nerve problems (such as confusion, and difficulty speaking/walking) caused by Wilson's disease. In cystinuria, it helps decrease the amount of a certain substance (cystine) by binding to that substance which can cause kidney stones and prevent it from building up and forming stones. Besides this, Penicillamine is also used to treat lead poisoning.
Directions for Use
Storage
Side Effects of Penicillamine
- Protein in urine
- Low blood platelets
- Stomach upset
- Diarrhoea
- Change in taste
- Loss of appetite
- Mouth irritation
- Mouth sores
In-Depth Precautions and Warning
Drug Warnings
Do not take Penicillamine if you are allergic (hypersensitive) to penicillamine or any of the other ingredients in it. Inform your doctor if you have severe kidney problems, lupus erythematosus (an auto-immune disorder), agranulocytosis (a low white cell blood count), aplastic anaemia (symptoms including feeling tired, breathless, having pale skin and more susceptible to infection) or thrombocytopenia (a blood disorder which causes bleeding into your skin, bruising and bleeding more than normal). Do not take Penicillamine if you are pregnant or planning to get pregnant and breastfeeding. This medicine may cause harm to the unborn baby if you take it while you are pregnant. Caution should be required while taking Penicillamine by elderly patients as they may be at greater risk of suffering side effects if you are taking Penicillamine over a long time, especially if you are on a restricted diet, as this medicine increases the requirement for pyridoxine (Vitamin B6) so your doctor may also prescribe this vitamin for you. If you are taking iron tablets, antacids, or digoxin (used to treat heart failure), please maintain two hours gap between these tablets and Penicillamine. Low blood cell counts have happened while taking Penicillamine. If blood cell counts get very low, this can lead to bleeding problems, infections, or anaemia, and sometimes, these have been deadly.
Drug Interactions
Drug-Drug Interactions: Penicillamine interacts with medicine used to treat low iron levels or anaemia (carbonyl iron, heme iron polypeptide), medicine used to treat rheumatoid arthritis (gold sodium thoimalate, auranofin, aurothioglucose), a medicine used to treat heart conditions (digoxin), antacids (aluminium hydroxide, aluminium carbonate), non-steroidal anti-inflammatory drugs (NSAIDs) (ibuprofen, indomethacin, naproxen, oxyphenbutazone, phenylbutazone), anti-malarial agents (chloroquine, hydroxychloroquine), the medicine used to treat the mental illness schizophrenia (clozapine), a medicine used in the treatment of Parkinson's disease (levodopa) medicines to treat cancers(azathioprine, cyclophosphamide), immunosuppressive drugs (mycophenolate, cyclosporine), and zinc.
Drug-Food Interactions: Do not take copper-containing foods like shellfish, chocolate, nuts, mushroom, and organ meats (liver pate, sweetbreads etc.)
Drug-Disease Interactions: Penicillamine should not be used in people with bone marrow suppression, kidney dysfunction, liver disease, anaemia, asthma and allergies.
Drug-Drug Interactions Checker List:
Safety Advice
Alcohol
unsafeYou are recommended to avoid alcohol consumption while taking Penicillamine. It could lead to increased dizziness and drowsiness.
Pregnancy
unsafePenicillamine is a pregnancy category D drug. It is not recommended to take Penicillamine while you are pregnant. Penicillamine may cause serious birth defects.
Breast Feeding
unsafePenicillamine should not be used in breastfeeding mothers as Penicillamine passes into breast milk.
Driving
cautionPenicillamine may cause dizziness, drowsiness and tiredness; do not drive or operate heavy machinery if you feel dizzy.
Liver
unsafePenicillamine is not recommended for the liver patients.
Kidney
cautionPenicillamine should be used with caution in patients with kidney diseases. Dose adjustments may be necessary.
Children
safe if prescribedPenicillamine should be used in children under the care of the doctor. The dose may depend on the weight and age of the child.
Habit Forming
Diet & Lifestyle Advise
- Physical activity helps in strengthening muscles and relieves joint stiffness. Gentle activities like 20-30 minutes of walking or swimming would be helpful.
- Performing yoga may also help in improving joint flexibility and pain management.
- Maintain a healthy weight by performing regular low-strain exercises and eating healthy food.
- Get adequate sleep as resting the muscles can help in reducing inflammation and swelling.
- Follow heat or cold therapy, apply a cold or hot compress on the joints for 15-20minutes regularly.
- De-stress yourself by meditating, reading books, taking a warm bubble bath or listen to soothing music.
- Acupuncture, massage and physical therapy may also be helpful.
- Eat food rich in antioxidants such as berries, spinach, kidney beans, dark chocolate, etc.
- Foods containing flavonoids help in reducing inflammation. These include soy, berries, broccoli, grapes and green tea.
- Drink plenty of fluids.
- Limit consumption of spinach, wheat bran, nuts, beets and dairy products.
- Avoid high salt intake and foods containing baking soda.
- Follow work safety regulations if you are at risk of occupational exposure. Wear necessary protective gear while working and do not take any contaminated material such as clothing or work gear to home.
- Avoid smoking and alcohol consumption.
Special Advise
- Your doctor may advise you to take blood and urine tests while using Penicillamine to examine your health condition and ensure that this medicine treats your condition.
- Avoid using copper containers for drinking, cooking and eating. Ensure running water you drink should be reduced copper level up to the minimum.
- If you are using any nutritional supplements or herbal supplements which contains copper tell your doctor about this. Your doctor may suggest any other alternative to this.
Patients Concern
Disease/Condition Glossary
Rheumatoid arthritis: It is an autoimmune disease (the body's immune system attacks its tissue), leading to joint pain and damage. Symptoms of rheumatoid arthritis include pain, inflammation of joints, difficulty moving, and swelling.
Wilson’s disease: It is a rare genetic disorder that causes excess copper in the body. Copper plays an important role in developing healthy nerves, bones, collagen, and the skin pigment melanin. Normally, copper is absorbed from the food; the liver filters out excess copper and releases it through urine. In People with Wilson’s disease, the liver cannot remove the extra copper properly, and the extra copper then builds up in organs such as the brain, liver, and eyes.
Cystinuria: It is the condition in which the amino acid called cystine in the urine, leading to the formation of cystine stones in the kidneys, ureters, and bladder. Cystinuria symptoms are usually sharp pain in the lower back or side of the abdomen (renal colic), blood in the urine (hematuria), obstruction of the urinary tract, and infections of the urinary tract.
FAQs
Penicillamine works by blocking the action of certain chemical messengers that are responsible for inflammation and prevents joint stiffness, thereby provides relief from rheumatoid arthritis.
Wilson’s disease is a condition where the body cannot get rid of copper properly and cause damage the liver, brain, and other organs. Penicillamine contains penicillamine that works by helping the body to remove excess copper.
Avoid taking other medicines at the same time while taking Penicillamine. If you take an iron supplement, take it at least 2 hours before or after you take Penicillamine. Iron can make it harder for your body to absorb Penicillamine. Avoid taking mineral supplements, unless your doctor advised you to. Do not drink milk within 1 hour before or after you take Penicillamine. Do not take copper-containing foods like shellfish, chocolate, nuts, mushroom, and organ meats (liver pate, sweetbreads etc.)
Penicillamine may cause side-effects such as protein in urine, low blood platelets, stomach upset or throwing up, diarrhea , change in taste, loss of appetite, mouth irritation, mouth sores. These side-effects are usually mild and temporary. However, if any of these side-effects persist or get worse, inform your doctor immediately.
Penicillamine should not be taken during pregnancy or if you are trying to become pregnant as Penicillamine can cause birth defects, miscarriages or harm unborn babies. Avoid becoming pregnant for at least 6 months after stopping the treatment with Penicillamine.
