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Penicillamine Brand Names
Cuprimine | Depen | D-PENAMINE
What is Penicillamine
Penicillamine is an oral chelating agent used in the treatment of patients with Wilson’s disease, cystinuria, and resistant cases of rheumatoid arthritis.
Although it is structurally dissimilar from beta-lactams, penicillamine is identified as a breakdown product of penicillin metabolism.
Penicillamine, however, has no antibacterial properties.
The chelating properties of the drug were discovered in 1953, when it was first found in the urine of patients with liver disease being treated with penicillin.
The drug is now used in the removal of excess copper from the circulation of patients with Wilson’s disease and in the reduction of cystine excretion in patients with cystinuria.
The D-isomer of penicillamine is used clinically and is prepared synthetically, thereby reducing the incidence of penicillin hypersensitivity reactions.
Indications
- arsenic toxicity
- cystinuria
- juvenile rheumatoid arthritis (JRA)/juvenile idiopathic arthritis (JIA)
- lead toxicity
- rheumatoid arthritis
- scleroderma (systemic sclerosis)
- Wilson’s disease
For the treatment of Wilson’s disease (hepatolenticular degeneration)
Side Effects
- agitation
- agranulocytosis
- alopecia
- anorexia
- anxiety
- aplastic anemia
- arthralgia
- bleeding
- breast enlargement
- bronchiolitis obliterans
- cheilitis
- chills
- cholestasis
- cough
- diarrhea
- diplopia
- dysgeusia
- dyspnea
- ecchymosis
- eosinophilia
- exfoliative dermatitis
- fever
- glomerulonephritis
- glossitis
- Guillain-Barre syndrome
- hematuria
- hemolysis
- hemolytic anemia
- hemoptysis
- hepatic failure
- hepatitis
- hypoglycemia
- leukocytosis
- leukopenia
- lichen planus-like eruption
- lupus-like symptoms
- lymphadenopathy
- maculopapular rash
- myalgia
- myasthenia
- nail discoloration
- nausea
- nephrolithiasis
- nephrotic syndrome
- nephrotoxicity
- new primary malignancy
- optic neuritis
- oral ulceration
- pancreatitis
- pancytopenia
- pemphigus
- peptic ulcer
- peripheral neuropathy
- pharyngitis
- phlebitis
- proteinuria
- pruritus
- ptosis
- rash
- red cell aplasia
- renal failure (unspecified)
- sideroblastic anemia
- stomatitis
- synovitis
- thrombocytopenia
- thrombocytosis
- thrombotic thrombocytopenic purpura (TTP)
- tinnitus
- toxic epidermal necrolysis
- urticaria
- vasculitis
- vitamin B6 deficiency
- vomiting
- weakness
- wheezing
Monitoring Parameters
- CBC
- hemoglobin/hematocrit
- LFTs
- platelet count
- urinalysis
Contraindications
- agranulocytosis
- aplastic anemia
- bone marrow suppression
- breast-feeding
- caesarean section
- children
- cholestasis
- diabetes mellitus
- fever
- geriatric
- hematological disease
- hematuria
- hepatitis
- hepatotoxicity
- hypoglycemia
- jaundice
- myasthenia gravis
- nephrolithiasis
- nephrotoxicity
- neutropenia
- pemphigus vulgaris
- penicillamine hypersensitivity
- penicillin hypersensitivity
- pregnancy
- proteinuria
- renal failure
- renal impairment
- requires an experienced clinician
- serious rash
Interactions
- Ado-Trastuzumab emtansine
- Aldesleukin, IL-2
- Alemtuzumab
- Altretamine
- Aluminum Hydroxide
- Aluminum Hydroxide; Magnesium Carbonate
- Aluminum Hydroxide; Magnesium Hydroxide
- Aluminum Hydroxide; Magnesium Hydroxide; Simethicone
- Aluminum Hydroxide; Magnesium Trisilicate
- Antacids
- Antimalarials
- Antineoplastic Agents
- Antithymocyte Globulin
- Arsenic Trioxide
- Aspirin, ASA; Citric Acid; Sodium Bicarbonate
- Atezolizumab
- Auranofin
- Avelumab
- Azacitidine
- Basiliximab
- Belinostat
- Bendamustine
- Bevacizumab
- Bexarotene
- Bleomycin
- Blinatumomab
- Brentuximab vedotin
- Busulfan
- Cabazitaxel
- Calaspargase pegol
- Calcium Carbonate
- Calcium Carbonate; Magnesium Hydroxide
- Calcium Carbonate; Risedronate
- Calcium Carbonate; Simethicone
- Capecitabine
- Carboplatin
- Carmustine, BCNU
- Cemiplimab
- Cetuximab
- Chlorambucil
- Cisplatin
- Cladribine
- Clofarabine
- Corticosteroids
- Cyclophosphamide
- Cytarabine, ARA-C
- Dacarbazine, DTIC
- Dactinomycin, Actinomycin D
- Daratumumab
- Daratumumab; Hyaluronidase
- Daunorubicin
- Daunorubicin Liposomal
- Daunorubicin Liposomal; Cytarabine Liposomal
- Decitabine
- Denileukin Diftitox
- Denosumab
- Digoxin
- Dinutuximab
- Docetaxel
- Doxorubicin
- Doxorubicin Liposomal
- Durvalumab
- Efalizumab
- Elotuzumab
- Epirubicin
- Eribulin
- Estramustine
- Etoposide, VP-16
- Everolimus
- Floxuridine
- Fludarabine
- Fluorouracil, 5-FU
- Foscarnet
- Gemcitabine
- Gemtuzumab Ozogamicin
- Gold
- Gold Sodium Thiomalate
- Hydroxyurea
- Ibritumomab Tiuxetan
- Idarubicin
- Ifosfamide
- Inotuzumab Ozogamicin
- Interferon Alfa-2a
- Interferon Alfa-2b
- Interferon Alfa-2b; Ribavirin
- Iobenguane I 131
- Ipilimumab
- Irinotecan
- Irinotecan Liposomal
- Iron
- Ixabepilone
- L-Asparaginase Escherichia coli
- Lomustine, CCNU
- Lutetium Lu 177 dotatate
- Magnesium Hydroxide
- Mechlorethamine, Nitrogen Mustard
- Melphalan
- Mercaptopurine, 6-MP
- Methotrexate
- Methoxsalen
- Midostaurin
- Mitomycin
- Mitotane
- Mitoxantrone
- Mogamulizumab
- Moxetumomab pasudotox
- Muromonab-CD3
- Nanoparticle Albumin-Bound Paclitaxel
- Necitumumab
- Nelarabine
- Nivolumab
- Obinutuzumab
- Ofatumumab
- Olaratumab
- Omacetaxine
- Omeprazole; Sodium Bicarbonate
- Oxaliplatin
- Paclitaxel
- Panitumumab
- Panobinostat
- Pegaspargase
- Pembrolizumab
- Pemetrexed
- Pentostatin
- Pertuzumab
- Plicamycin
- Porfimer
- Pralatrexate
- Procarbazine
- Pyridoxine, Vitamin B6
- Ramucirumab
- Rituximab
- Rituximab; Hyaluronidase
- Romidepsin
- Sodium Bicarbonate
- Sodium picosulfate; Magnesium oxide; Anhydrous citric acid
- Streptozocin
- Tagraxofusp
- Talimogene Laherparepvec
- Telbivudine
- Temozolomide
- Temsirolimus
- Teniposide
- Thioguanine, 6-TG
- Thiotepa
- Topotecan
- Tositumomab
- Trabectedin
- Trastuzumab
- Trastuzumab; Hyaluronidase
- Tretinoin, ATRA
- Trifluridine; Tipiracil
- Venetoclax
- Vinblastine
- Vincristine
- Vincristine Liposomal
- Vinorelbine
- Vorinostat
- Ziv-Aflibercept
