See Supplemental Patient Information
- Fatalities due to aplastic anemia, agranulocytosis, thrombocytopenia, Goodpasture's syndrome, and myasthenia gravis have occurred in patients taking penicillamine
- Once treatment is started it should be preferably continued on a daily basis as interruptions for even a few days have been followed by sensitivity reactions
- On reduction of WBC below 3500/mm3 discontinue therapy
- Leukopenia and thrombocytopenia have occurred in patients during penicillamine therapy
- Even in the absence of clinical bleeding if platelet count <100,000/mm3 temporary cease therapy
- Temporarily cease therapy if values for platelet count/WBC are still within the normal range but progressively decreasing in three successive determinations
- Proteinuria and/or hematuria progressing to a nephrotic syndrome have occurred. Physician must ascertain whether it is a sign of drug-induced glomerulopathy or is unrelated to penicillamine. Closely monitor patients. Some patients may require cessation of therapy on persistent proteinuria and/or hematuria
- Proteinuria exceeding 1 g/24 hours, or progressively increasing proteinuria requires either discontinuance of the drug or a reduction in the dosage
- Discontinue dosage if RA patients develop gross hematuria/persistent microscopic hematuria
- Weigh potential benefit/risk in patients with Wilson's disease or cystinuria due to manifestations of potentially serious urinary abnormalities
- Perform an annual x-ray for renal stones in patients with cystinuria
- On occurrence of abnormal urinary findings associated with hemoptysis and pulmonary infiltrates on x-ray, immediate cessation of therapy is required
- Rare occasions of obliterative bronchiolitis have occurred
- Myasthenic syndrome sometimes progressing to myasthenia gravis, pemphigus vulgaris and pemphigus foliaceus has occurred. Discontinue therapy on occurrence of pemphigus
- Avoid interruptions for even a few days as sensitivity reactions after reinstitution of therapy have occurred
- Monitor RA patients who develop moderate degrees of proteinuria; continue dosage cautiously and obtain quantitative 24-hour urinary protein levels q1-2 wks. Do not up titrate under these circumstances
- Monitor creatinine clearance at baseline; CBC w/ differential count, Platelets, urinalysis, temperature, skin/lymph node monitoring twice weekly x 1 month, then q2 wks x 5 months, then qmo thereafter
- Monitor LFTs q6 months or if Wilson's disease q3 months for 1 yr, then q6 months
- Patients may experience drug fever in the second to third week following initiation of therapy accompanied by a macular eruption; temporarily discontinue drug and later reinstitute in small doses
- Iron deficiency may develop especially in pediatric patients and in menstruating women
- In Wilson's disease, penicillamine causes an increase in the amount of soluble collagen causing increased skin friability. Consider a dose reduction to 250 mg/day when surgery is contemplated; full therapy delayed until wound healing is complete
Cautions: Use cautiously in
- Renal impairment
- Myelosuppression
- Neurological disorder
- Iron deficiency
- Surgery
- Pregnancy (in Wilson's disease, limit daily intake to < 1 g, if cesarean planned, decrease daily dose to 250 mg for last 6 wks of pregnancy and until incision is healed)
- Geriatric population
Supplemental Patient Information
- Instruct patients to report promptly the development of signs and symptoms of granulocytopenia and/or thrombocytopenia such as fever, sore throat, chills, bruising or bleeding
- Caution patients to report immediately pulmonary symptoms such as exertional dyspnea, unexplained cough or wheezing
- Advise patients to intake a pint of fluid at qhs drink and another pint once during the night when urine is more concentrated and more acidic than during the day
Pregnancy Category:D
Breastfeeding: Unsafe; Breastmilk transfer to the infant is likely to be low because of high protein binding (80%) and short half-life. Some data suggest that use of penicillamine is unacceptable during lactation. In infants who breastfeed infrequently, take the drug right after nursing and wait for 4-6 hrs before nursing to minimize the amount in breastmilk. Implications for infants due to reduced levels of copper and zinc levels in breastmilk are not known. This information is based on LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 15 December 2010). Contraindicated according to the manufacturer.
Pricing data from www.DrugStore.com in U.S.A.
- Cuprimine 250 MG CAPS [Bottle] (VALEANT)
30 mg = $220
90 mg = $635.95 - Depen Titratabs 250 MG TABS [Bottle] (MEDA PHARMACEUTICALS)
30 mg = $146.99
90 mg = $419.97
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
