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penicillamine (Cuprimine, Depen)

Tradenames: Cuprimine, Depen. (D-penicillamine) Indications: - adjunct agent in treatment of rheumatoid arthritis, vasculitis - hepatolenticular degeneration (Wilson's disease) - cystinuria, cystine renal calculi - lead poisoning - primary biliary cirrhosis Dosage: 1) take on an empty stomach 1 hour before or 2 hours after meals & at least 1 hour apart from other drugs 2) give 25 mg of pyridoxine daily because of increased requirements 3) rheumatoid arthritis: a) start: 125-250 mg PO QD b) increase at 1-3 month intervals by 125-250 mg/day c) continue to increase the dose at 2-3 month intervals until a satisfactory response is obtained d) if no response with 1-1.5 g doses, assume that therapy with penicillamine does NOT work 4) hepatolenticular degeneration (Wilson's disease) a) 1-2 g QD b) dose adjustment via urinary copper analysis 5) cystinuria: 1-4 g/day Capsule: (Cupramine) 125 mg. Tablet: (Depen) 250 mg. Pharmacokinetics: 1) onset of therapeutic response: a) up to 2-3 months in rheumatoid arthritis b) up to 1-3 months Wilson's disease 2) excreted in urine & feces 3) elimination 1/2life ranges from 1.7-3.2 hours Adverse effects: 1) common (> 10%) - fever, joint pain, rash, urticaria, itching, loss of taste 2) less common (1-10%) - sore throat, fever/chills, white spots on lips or mouth, aplastic anemia, bloody or cloudy urine, swelling of face or lower extremities, weight gain, hemolytic anemia, leukopenia, agranulocytosis, thrombocytopenia, 3) uncommon (< 1%) - cough, wheezing, spitting of blood, weakness, tiredness, cholestatic jaundice, myasthenia gravis-like syndrome, toxic epidermal necrolysis, optic neuritis, tinnitus, pemphigus, increased friability of the skin, iron deficiency, nausea/vomiting, hepatic dysfunction, arthralgia, proteinuria, nephrotic syndrome, allergic reactions, lymphadenopathy 4) other [2] - drug-induced lupus erythematosus (< 1%) - pulmonary fibrosis - bronchiolitis obliterans with organizing pneumonia (BOOP) - Goodpasteur syndrome-like illness - diffuse alveolitis - aplastic anemia (fatalities have occurred) - sideroblastic anemia - mild elevation in serum transaminases - oral ulcerations - hematuria - GI intolerance Drug interactions: 1) gold therapy, antimalarials, cytotoxic drugs, phenylbutazone in combination may result in serious hematologic & renal reactions 2) penicillamine increases serum digoxin levels 3) decreased effect with iron & zinc salts, antacids (Mg+2, Al+3, Ca+2) & food Mechanism of action: 1) rheumatoid arthritis a) unknown, but may suppress disease activity b) diminshes IgM rheumatoid factor c) no significant decrease in total immunoglobulins d) may inhibit T-cell function e) may act as an antioxidant by inhibiting release of 1] lysosomal enzymes 2] active oxygen species 2) hepatolenticular degeneration (Wilson's disease) - chelating agent that removes excess copper 3) cystinuria: reduces excess cystine excretion 4) effective chelator of copper, mercury, lead, zinc [5]

Related

bronchiolitis obliterans; constrictive bronchiolitis; cryptogenic organizing pneumonia; bronchiolitis obliterans with organizing pneumonia (BOOP) cystinuria drug-induced lupus erythematosus hepatolenticular degeneration; Wilson's disease primary biliary cirrhosis; primary biliary cholangitis rheumatoid arthritis (RA)

General

amine carboxylic acid chelating agent disease-modifying antirheumatic agent (DMARD) pharmaceutical angiogenesis inhibitor (angiostatic agent) thiol; sulhydryl compound; mercaptan

Properties

MISC-INFO: elimination route KIDNEY FECES 1/2life 1.7-3.2 HOURS pregnancy-category D safety in lactation -

Database Correlations

PUBCHEM correlations

References

  1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 763
  2. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
  3. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  4. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  5. Goodman and Gilman's The Pharmacological Basis of Therapeutics, 8th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1990. pg 1610
  6. Deprecated Reference