penicillamine: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
penicillamine: clinical details
Prescribing considerations
- Confirm the indication and specialist oversight; clinical benefit in rheumatoid arthritis may be delayed.
- Assess previous reactions to penicillamine or gold, renal disease, urinary abnormalities and concurrent nephrotoxic or myelosuppressive treatment.
- Older people require particularly careful toxicity monitoring.
- Penicillamine is not a penicillin antibiotic; record penicillin and penicillamine allergies accurately and separately.
Contraindications and cautions
- Hypersensitivity to penicillamine or a formulation excipient
- Previous penicillamine-induced agranulocytosis, aplastic anaemia or severe thrombocytopenia
- Lupus erythematosus
- Moderate or severe renal impairment
Monitoring
- Before treatment: full blood count including platelets, renal function and urinalysis; assess liver biochemistry and albumin where clinically appropriate.
- During treatment: regular blood counts, renal assessment and urinalysis for haematuria and proteinuria, with additional checks after treatment changes.
- Withhold and urgently investigate unexpected bruising, bleeding, sore throat, fever, infection, severe rash or oral ulceration.
- Review increasing or persistent proteinuria with the specialist; recurrent leucopenia or thrombocytopenia may require permanent withdrawal.
Clinical pharmacology
A thiol-containing chelator with variable gastrointestinal absorption and strong plasma-protein binding. It is not extensively metabolised; absorbed material is eliminated mainly in urine as disulfides and metal complexes. Its antirheumatic mechanism remains incompletely defined.
Formulation and product differences
- The selected product is a film-coated tablet containing lactose and is essentially sodium-free.
- This tablet formulation is not suitable for penicillamine desensitisation.
penicillamine preparations and strengths
Tablet
Route: Oral
Strengths: 125 mg, 250 mg
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.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.