Penicillamine

WHY is this medicine prescribed?

Penicillamine is used to treat Wilson's disease (an inherited condition that causes copper to build up in the body and may result in serious symptoms) and cystinuria (an inherited condition which can lead to kidney stones). It is also used in combination with other treatments to treat severe rheumatoid arthritis (a condition in which the body's immune system attacks its own joints, causing pain, swelling, and loss of function) that did not get better after treatment with other medications. Penicillamine is in a class of medications called heavy metal antagonists. It works to treat Wilson's disease by binding to the extra copper in the body and causing it to leave the body through the urine. It works to treat cystinuria by binding to the substance that makes kidney stones and preventing it from building up and forming stones. It works to treat rheumatoid arthritis by decreasing some actions of the immune system.

Are there OTHER USES for this medicine?

Penicillamine is also sometimes used as a follow up treatment for lead poisoning after it was treated with other medications. It is also sometimes used to treat certain types of liver disease. Talk to your doctor about the risks of using this medication for your condition.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

HOW should this medicine be used?

Penicillamine comes as a capsule and as a tablet to take by mouth. It is usually taken on an empty stomach at least 1 hour before or 2 hours after a meal, and at least 1 hour before or after any food or milk. For the treatment of Wilson's disease and cystinuria, penicillamine is usually taken four times a day. For the treatment of rheumatoid arthritis it is usually take once a day, but at increased dosages, it may be taken up to four times a day. Your doctor will recommend how long you should receive treatment based on your condition, how well your body responds to the medication, and any side effects that you experience. Take penicillamine at around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take penicillamine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Your doctor will probably start you on a low dose of penicillamine and gradually increase your dose.

For the treatment of Wilson's disease and rheumatoid arthritis it may take one to three months or longer before you feel the full benefit of penicillamine. For all uses continue to take penicillamine even if you feel well. Do not stop taking penicillamine without talking to your doctor, even if your symptoms worsen. If you stop taking penicillamine you are at an increased risk of experiencing an allergic reaction when you start taking the medication again.

Be sure to tell your doctor how you are feeling during your treatment with penicillamine. Your doctor may treat you with other medications, or delay your treatment, reduce your dosage, or stop your treatment depending on the side effects that you experience.

What SPECIAL PRECAUTIONS should I follow?

Before taking penicillamine,

• tell your doctor and pharmacist if you are allergic to penicillamine, penicillin, any other medications, or any of the ingredients in penicillamine capsules or tablets. Ask your pharmacist for a list of the ingredients.

• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: gold compounds such as auranofin (Ridaura) and aurothioglucose (Solganol); antimalarial medications such as chloroquine, hydroxychloroquine (Plaquenil); and certain immunosuppressants such as azathioprine (Azasan, Imuran), and methotrexate (Otrexup, Rasuvo, Trexall, Xatmep). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Many other medications may also interact with penicillamine, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list.

• if you are taking an iron containing product, take it 2 hours before or after if you take penicillamine. If you are taking any other medication, antacid, or zinc containing product, take them 1 hour before or after you take penicillamine.

• tell your doctor if you have ever been treated with penicillamine in the past and developed a severe blood related side effect. Your doctor will probably tell you not to take penicillamine again.

• tell your doctor if you have ever had a serious reaction to gold compounds, or if you have or have ever had kidney disease.

• tell your doctor if you are pregnant, or if you plan to become pregnant. If you become pregnant while taking penicillamine, call your doctor immediately.

• tell your doctor if you are breastfeeding. You should not breastfeed while you are receiving treatment with penicillamine.

• your doctor will probably tell you to take a pyridoxine (vitamin B₆) supplement during your treatment with penicillamine.

What SPECIAL DIETARY instructions should I follow?

If you are being treated for Wilson's disease your doctor will probably recommend a special diet for you that is low in copper. This diet avoids cereals and dietary supplements that are enriched with copper, chocolate, nuts, shellfish, mushrooms, liver, molasses, broccoli, and other high copper containing foods. Your doctor may also recommend that you drink distilled or demineralized water, instead of regular tap water. Be sure to follow all dietary recommendations made by your doctor.

If you are being treated for cystinuria your doctor may recommend a special diet for you that is low in methionine (a type of protein). However if you are a child or if you are pregnant your doctor may not recommend this diet. Your doctor will also probably recommend that you drink enough liquids.

If you are being treated for rheumatoid arthritis, continue your normal diet unless your doctor tells you otherwise.

What should I do IF I FORGET to take a dose?

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What SIDE EFFECTS can this medicine cause?

Penicillamine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• loss of appetite
• change in the way things taste
• nausea
• vomiting
• diarrhea
• abdominal pain
• wrinkling of skin
• nail changes

Some side effects can be serious. If you experience any of these symptoms call your doctor immediately:

• rash, itching, hives, shedding skin, fever, joint pain, or swollen lymph nodes
• painful or itchy blisters and sores on the skin, mouth, and genitals
• fever, sore throat, chills, unusual bleeding or bruising
• shortness of breath, unexplained cough or wheezing
• foamy or pink, red, brown, or bloody urine
• muscle weakness, drooping eyelids, or double vision

Penicillamine may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

What should I know about STORAGE and DISPOSAL of this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

What should I do in case of OVERDOSE?

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

What OTHER INFORMATION should I know?

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to penicillamine.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.