Penicillamine

Indications & Dose:

INDICATIONS AND DOSE

Severe active rheumatoid arthritis (administered on expert advice)

• BY MOUTH

Adult: Initially 125–250 mg daily for 1 month, then increased in steps of 125–250 mg, at intervals of not less than 4 weeks; maintenance 500–750 mg daily in divided doses, then reduced in steps of 125–250 mg every 12 weeks, dose reduction attempted only if remission sustained for 6 months;n maximum 1.5 g per day

Elderly: Initially up to 125 mg daily for 1 month, then increased in steps of up to 125 mg, at intervals of at least 4 weeks; maximum 1 g per day Wilson’s disease

• BY MOUTH

Adult: 1.5–2 g daily in divided doses, adjusted according to response, to be taken before food; maintenance 0.75–1 g daily, a dose of 2 g daily should not be continued for more than one year; maximum 2 g per day

Elderly: 20 mg/kg daily in divided doses, adjusted according to response

Autoimmune hepatitis (used rarely; after disease controlled with corticosteroids)

• BY MOUTH

Adult: Initially 500 mg daily in divided doses, to be increased slowly over 3 months; maintenance 1.25 g daily

Cystinuria, therapeutic

• BY MOUTH

Adult: 1–3 g daily in divided doses, to be adjusted to maintain urinary cystine below 200 mg/litre, to be taken before food

Cystinuria, prophylactic

• BY MOUTH

Adult: 0.5–1 g daily, maintain urinary cystine below 300 mg/litre and adequate fluid intake (at least 3 litres daily), to be taken at bedtime

Elderly: Minimum dose to maintain urinary cystine below 200 mg/litre is recommended

Contraindications:

Lupus erythematosus

Side Effects:

Common or very common Anorexia . fever . nausea . proteinuria . rash . thrombocytopenia Rare Alopecia . breast enlargement (male and female) . elastosis perforans . haematuria (withdraw immediately if cause unknown) . mouth ulceration . pseudoxanthoma elasticum . skin laxity . stomatitis

Frequency not known Agranulocytosis . aplastic anaemia . blood disorders . bronchiolitis . cholestatic jaundice . dermatomyositis . glomerulonephritis . Goodpasture’s syndrome . haemolytic anaemia . haemolytic leucopenia . late rashes (consider dose reduction) . lupus erythematosus . myasthenia gravis . nephrotic syndrome . neuropathy (especially if neurological involvement in Wilson’s disease—prophylactic pyridoxine recommended) . neutropenia . pancreatitis . pemphigus . pneumonitis .

polymyositis . pulmonary haemorrhage . rheumatoid arthritis . septic arthritis (in patients with rheumatoid arthritis) . Stevens-Johnson syndrome . taste loss (mineral supplements not recommended) . urticaria . vomiting

Cautions:

Neurological involvement in Wilson’s disease

Precautions:

Interaction:

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Lactations:

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Counselling:

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Patient And Carer Advice: