View source for Penicillamine

==Administration==
*Type: [[Antidote]], anti-rheumatic
*Dosage Forms:
*Routes of Administration: Oral
*Common Trade Names: Cuprimine, Depen

==Adult Dosing==
*Mercury toxicity: 250mg PO QID x 1-2wks
*Arsenic toxicity: 100 mg/kg/day PO divided q6hr x 5 days
*Lead toxicity: 1-1.5 g daily PO or divided BID-TID x 1-6 months
*Cystinuria: 1-4g/day PO, goal urinary cysteine excretion 100 to 200 mg/day in patients with no stone history, <100mg/day if history of stones/pain
*Rheumatoid arthritis: 125-1500mg/day PO
*Wilson's disease: 750-1500mg/day, based on urinary copper excretion
==Pediatric Dosing==
*Lead toxicity (3rd line): 20-40 mg/kg/day PO divided q8hr
*Wilson's disease: 20 mg/kg/day PO divided q12hr
*Cystinuria: 30 mg/kg/day PO divided BID/QID, max 1g/day

==Special Populations==
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: D
*[[Lactation risk categories|Lactation risk]]: Infant risk cannot be ruled out
*Renal dosing: avoid in moderate to severe renal impairment
*Hepatic dosing: no adjustment

==Contraindications==
*Allergy to class/drug
*Pregnancy
*History of penicillamine-related aplastic anemia or agranulocytosis
*Rheumatoid arthritis with renal insufficiency

==Adverse Reactions==
===Serious===
*SJS/TEN, pemphigus
*Agranulocytosis, aplastic anemia, thrombocytopenia, TTP, ALL
*Liver failure, toxic hepatitis, cholestatic hepatitis, pancreatitis
*Renal failure, renal vasculitis, nephrotic syndrome
*Myasthenia gravis, optic neuritis
*Extrinsic allergic alveolitis, interstitial pneumonia, obliterative bronchiolitis
*Drug fever
===Common===
*Nausea/vomiting, decreased appetite, oral ulcers, diarrhea, epigastric pain
*Rash
*Proteinuria
*Myelosuppression

==Pharmacology==
*Half-life: 
*Metabolism: Hepatic
*Excretion: Renal and fecal

==Mechanism of Action==
*As chelator: binds to heavy metals to form stable, soluble complexes that are readily excreted in the urine
==Comments==

==See Also==
*[[Antidotes]]
*[[Lead toxicity]], [[Arsenic toxicity]], [[Mercury toxicity]]
==References==
<references/>
[[Category:Pharmacology]]