Penicillamine: Difference between revisions
ClaireLewis (talk | contribs) (Created page with "==Administration== *Type: Antidote, anti-rheumatic *Dosage Forms: *Routes of Administration: Oral *Common Trade Names: Cuprimine, Depen ==Adult Dosing== *Mercury toxicity...") |
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==Adult Dosing== | ==Adult Dosing== | ||
*Mercury toxicity: 250mg PO QID x 1-2wks | *[[Mercury toxicity]]: 250mg PO QID x 1-2wks | ||
*Arsenic toxicity: 100 mg/kg/day PO divided q6hr x 5 days | *[[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 | *[[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 | *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 | *[[Rheumatoid arthritis]]: 125-1500mg/day PO | ||
*Wilson's disease: 750-1500mg/day, based on urinary copper excretion | *[[Wilson's disease]]: 750-1500mg/day, based on urinary copper excretion | ||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
*Lead toxicity (3rd line): 20-40 mg/kg/day PO divided q8hr | *[[Lead toxicity]] (3rd line): 20-40 mg/kg/day PO divided q8hr | ||
*Wilson's disease: 20 mg/kg/day PO divided q12hr | *[[Wilson's disease]]: 20 mg/kg/day PO divided q12hr | ||
*Cystinuria: 30 mg/kg/day PO divided BID/QID, max 1g/day | *Cystinuria: 30 mg/kg/day PO divided BID/QID, max 1g/day | ||
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===Serious=== | ===Serious=== | ||
*SJS/TEN, pemphigus | *SJS/TEN, pemphigus | ||
*Agranulocytosis, aplastic anemia, thrombocytopenia, TTP, ALL | *[[Agranulocytosis]], [[aplastic anemia]], thrombocytopenia, TTP, ALL | ||
*Liver failure, toxic hepatitis, cholestatic hepatitis, pancreatitis | *Liver failure, toxic hepatitis, cholestatic hepatitis, [[pancreatitis]] | ||
*Renal failure, renal vasculitis, nephrotic syndrome | *Renal failure, renal vasculitis, nephrotic syndrome | ||
*Myasthenia gravis, optic neuritis | *[[Myasthenia gravis]], optic neuritis | ||
*Extrinsic allergic alveolitis, interstitial pneumonia, obliterative bronchiolitis | *Extrinsic allergic alveolitis, interstitial pneumonia, obliterative bronchiolitis | ||
*Drug fever | *Drug fever | ||
===Common=== | ===Common=== | ||
*Nausea/vomiting, decreased appetite, oral ulcers, diarrhea, epigastric pain | *[[Nausea]]/[[vomiting]], decreased appetite, oral ulcers, [[diarrhea]], epigastric pain | ||
*Rash | *Rash | ||
*Proteinuria | *Proteinuria | ||
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==Pharmacology== | ==Pharmacology== | ||
*Half-life: | *Half-life: 4-6 days | ||
*Metabolism: Hepatic | *Metabolism: Hepatic | ||
*Excretion: Renal and fecal | *Excretion: Renal (50%) and fecal (30%) | ||
==Mechanism of Action== | ==Mechanism of Action== | ||
*As chelator: binds to heavy metals to form stable, soluble complexes that are readily excreted in the urine | *As chelator: binds to heavy metals to form stable, soluble complexes that are readily excreted in the urine | ||
*Anti-rheumatic: Mechanism unknown | |||
==Comments== | ==Comments== | ||
Revision as of 21:54, 8 September 2018
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
- Pregnancy Rating: D
- 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: 4-6 days
- Metabolism: Hepatic
- Excretion: Renal (50%) and fecal (30%)
Mechanism of Action
- As chelator: binds to heavy metals to form stable, soluble complexes that are readily excreted in the urine
- Anti-rheumatic: Mechanism unknown