Pharm

D-Penicillamine

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D-Penicillamine, Penicillamine

  • Indications
  1. Rheumatoid Arthritis Third-line DMARD agent
  2. Rheumatoid Nodulosis
  3. Wilson's Disease
  • Contraindications
  1. Penicillin Allergy
  • Efficacy
  1. Response in 70% of Rheumatoid Arthritis
  2. Slow response requires 4-6 months
  • Adverse Effects
  1. Adverse effects are common and require stopping drug
  2. Nausea
  3. Gastrointestinal upset
  4. Rash
  5. Stomatitis
  6. Dysgeusia
  7. Cytopenia (5%)
  8. Proteinuria in membranous nephritis (5-20%)
  1. Start low and increase very slowly
  2. Month 1: 250 mg per day
  3. Month 2: 500 mg per day
  4. Month 3: 750 mg per day
  5. Month 4: 1000 mg per day
  6. Maintenance Dose: 750 to 1000 mg per day
  7. Lowest Effective Dose: 500 mg per day
  1. Penicillamine 1 g PO before meals and at bedtime
  2. Keep Serum free copper <2 umol/L (<10 ug/dl)
  3. Continue life-long in Wilson's Disease
  • Monitoring (2-3 times weekly on starting Penicillamine)
  1. Complete Blood Count
  2. Platelet Count
  3. Urinalysis
  4. Body Temperature
  • Precautions
  1. Observe for Hypersensitivity Reaction
  2. Treat Hypersensitivity with Prednisone if occurs