Penicillamine

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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

  1. arsenic toxicity
  2. cystinuria
  3. juvenile rheumatoid arthritis (JRA)/juvenile idiopathic arthritis (JIA)
  4. lead toxicity
  5. rheumatoid arthritis
  6. scleroderma (systemic sclerosis)
  7. Wilson’s disease

For the treatment of Wilson’s disease (hepatolenticular degeneration)

Side Effects

  1. agitation
  2. agranulocytosis
  3. alopecia
  4. anorexia
  5. anxiety
  6. aplastic anemia
  7. arthralgia
  8. bleeding
  9. breast enlargement
  10. bronchiolitis obliterans
  11. cheilitis
  12. chills
  13. cholestasis
  14. cough
  15. diarrhea
  16. diplopia
  17. dysgeusia
  18. dyspnea
  19. ecchymosis
  20. eosinophilia
  21. exfoliative dermatitis
  22. fever
  23. glomerulonephritis
  24. glossitis
  25. Guillain-Barre syndrome
  26. hematuria
  27. hemolysis
  28. hemolytic anemia
  29. hemoptysis
  30. hepatic failure
  31. hepatitis
  32. hypoglycemia
  33. leukocytosis
  34. leukopenia
  35. lichen planus-like eruption
  36. lupus-like symptoms
  37. lymphadenopathy
  38. maculopapular rash
  39. myalgia
  40. myasthenia
  41. nail discoloration
  42. nausea
  43. nephrolithiasis
  44. nephrotic syndrome
  45. nephrotoxicity
  46. new primary malignancy
  47. optic neuritis
  48. oral ulceration
  49. pancreatitis
  50. pancytopenia
  51. pemphigus
  52. peptic ulcer
  53. peripheral neuropathy
  54. pharyngitis
  55. phlebitis
  56. proteinuria
  57. pruritus
  58. ptosis
  59. rash
  60. red cell aplasia
  61. renal failure (unspecified)
  62. sideroblastic anemia
  63. stomatitis
  64. synovitis
  65. thrombocytopenia
  66. thrombocytosis
  67. thrombotic thrombocytopenic purpura (TTP)
  68. tinnitus
  69. toxic epidermal necrolysis
  70. urticaria
  71. vasculitis
  72. vitamin B6 deficiency
  73. vomiting
  74. weakness
  75. 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

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