penicillamine at a glance
Medicine class
Chelating agent and disease-modifying antirheumatic treatment.
Licensed uses
Severe active rheumatoid arthritis, Wilson's disease, cystinuria, lead poisoning and chronic active hepatitis.
Administration
Swallow with water on an empty stomach, before food or at bedtime, as directed by the prescriber.
Safety monitoring
Regular blood and urine tests are essential because blood-cell and kidney problems may initially cause no symptoms.
What is penicillamine used for?
The selected UK product is licensed for:
Severe active rheumatoid arthritis, including juvenile forms
Wilson's disease in adults and children
Dissolving and preventing cystine stones in cystinuria
Lead poisoning in adults and children
Chronic active hepatitis in adults
How does penicillamine work?
Penicillamine binds copper and lead into soluble complexes that can leave the body in urine. In cystinuria it lowers urinary cystine, reducing stone formation and helping existing stones dissolve. Its precise disease-modifying mechanism in rheumatoid arthritis is not fully established, but it alters immune and inflammatory activity rather than acting as a painkiller.
penicillamine preparations and strengths
Tablet
Route: Oral
Strengths: 125 mg, 250 mg
How to take penicillamine
Take exactly as prescribed. Swallow the film-coated tablets with water on an empty stomach, before a meal or at bedtime. Food can reduce absorption; iron, antacids, zinc and digoxin should be taken separately as instructed by a clinician or pharmacist. Do not stop or change treatment without specialist advice, particularly when treating Wilson's disease.
Attend every scheduled blood and urine test.
Tell the prescriber about all prescription, non-prescription and mineral supplements.
The tablets contain lactose.
penicillamine side effects
Common or expected effects
- Protein in the urine, usually detected during monitoring
- Reduced platelet count, which may cause easier bruising or bleeding
- Nausea or reduced appetite
- Rash or itching
- Altered or lost taste
- Mouth soreness or ulcers
Get urgent medical advice
- Severe allergy with wheezing, swelling or breathing difficulty
- Low white cells or other serious blood disorders causing fever, sore throat, infection, weakness, bruising or bleeding
- Kidney inflammation, nephrotic syndrome, blood in the urine or increasing proteinuria
- Severe blistering or peeling skin reactions
- Coughing up blood or other serious lung inflammation
- Severe upper abdominal pain suggesting pancreatitis
- New marked muscle weakness, swallowing difficulty or breathing weakness
penicillamine in pregnancy
Penicillamine is generally avoided during pregnancy for rheumatoid arthritis or chronic active hepatitis. Wilson's disease and recurrent cystine stones require specialist risk–benefit decisions because stopping necessary treatment may also be harmful; contact the specialist promptly when planning pregnancy or if pregnancy occurs and do not stop treatment independently.
penicillamine while breastfeeding
Evidence during breastfeeding is limited, and the UK product information recommends use only when a specialist considers it absolutely essential. Discuss feeding options with the specialist before birth or before restarting treatment.
penicillamine interactions
A clinician or pharmacist should review all medicines and supplements, particularly:
Iron or antacids
They reduce penicillamine absorption and should be taken separately.
Zinc
Penicillamine and zinc can each reduce the other's absorption.
Digoxin
Penicillamine may reduce digoxin absorption, so separate administration may be required.
NSAIDs and other kidney-toxic medicines
Combined use may increase the risk of kidney damage.
Common questions about penicillamine
Answers are fully visible for fast scanning and source review.
Is penicillamine the same as penicillin?
No. Penicillamine is not an antibiotic and must not be confused with penicillin antibiotics.
Can I take penicillamine if I have a penicillin allergy?
A penicillin allergy does not automatically mean allergy to penicillamine, although rare cross-sensitivity is reported. The prescriber should review the exact previous reaction.
Why must penicillamine be taken on an empty stomach?
Food can reduce how much penicillamine is absorbed, making its effect less predictable.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.