Penicillamine is an anti-rheumatoid drug available as an oral capsule. This is used for the treatment of rheumatoid arthritis, Wilson’s disease, and cystinuria.  

Rheumatoid arthritis is a chronic inflammatory disorder that can affect more than just your joints. In some people, the condition can damage a wide variety of body systems (eyes, skin, lungs, heart or blood vessels). An autoimmune disorder, rheumatoid arthritis happens when your immune system mistakenly attacks your own body’s tissues. Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of your joints that causes painful swelling. That it can eventually result in bone erosion and joint deformity. Signs and symptoms of this condition may include:

  • Warm, tender, and swollen joints
  • Joint stiffness that is usually worse in the mornings and after inactivity
  • Fever, fatigue, and loss of appetite

Wilson’s disease is a rare inherited disorder that causes copper to accumulate in your brain, liver, and other vital organs. Copper plays a key role in the development of healthy bones, nerves, collagen, and the skin pigment melanin. Normally, copper is absorbed from your food and excess is excreted through a substance produced in your liver. Most people with this disease are diagnosed between the ages of 5 to 35. When diagnosed early, Wilson’s disease is treatable and many people with the illness live normal lives. Signs and symptoms vary depending on the parts of your body affected by the disease. They can include:

  • A yellowing of the skin and the whites of the eye
  • Lack of coordination, fatigue, or abdominal pain
  • Golden-brown eye discoloration
  • Fluid build-up in the legs or abdomen
  • Uncontrolled movements or muscle stiffness
  • Problems with speech, swallowing or physical coordination

Cystinuria is an inherited disorder of amino acid transport characterized by excessive excretion of lysine, cystine, and ornithine. Urolithiasis is caused by the relative insolubility of cystine in the urine. Symptoms often occur in childhood or early adult life, but cystinuria may become clinically evident at any age. 

Penicillamine is known as a disease-modifying antirheumatic drug (DMARD). This is also in the class of medication called heavy metal antagonists. This drug helps to decrease tenderness, pain or swelling in the joints. In Wilson’s disease, this drug binds to copper and helps it to be removed from the body. Lessening copper levels helps improve liver function and the mood or nerve problems caused by the disease. In the treatment of cystinuria, Penicillamine also lessens the amount of cystine in the urine which can cause kidney stones. This is a prescription approved by the Food and Drug Administration (FDA). Penicillamine is available in the dosage forms of 125mg or 250 mg. Each capsule contains Penicillamine as an active ingredient.

How does Penicillamine work?

In rheumatoid arthritis, Penicillamine works by suppressing the excessive activity of the immune system that causes the inflammation of the joints. This slows the progression of the underlying disease. It lessens the blood levels of certain inflammatory chemicals that the body’s immune system produces in rheumatoid arthritis. Once these have fallen, the inflammation of the joints lessens which helps relieve the pain.

Wilson’s disease, this drug binds to several heavy metals including copper, lead, and mercury forming complexes. These complexes are readily removed from the body by the kidneys and are excreted in the urine.

In cystinuria, Penicillamine decreases the amount of cystine that the kidneys filter into the urine. This helps prevent stones from forming and allows existing stones to gradually dissolve.

How to use Penicillamine?

This prescription is to be taken by mouth. Each dose is to be taken on an empty stomach or as directed by your doctor. Take each dose at least an hour apart from other medications, food, or milk. Swallow the tablet as a whole with a full glass of water. Do not break, chew, or crush it. Doing so can release the entire drug at once, increasing the risk of side effects. Remember to take it at the same time and in the same way each day. Take this medicine regularly for the best benefit.

The recommended dosage will depend on your medical condition, age, and response to the treatment. You must take this drug exactly as it is prescribed. You should not take this more or less than it is given by your doctor. Do not suddenly stop taking this medication without the consent of your doctor. If you missed a dose, take it as soon as you remember it. If it is almost time for your next dose, skip the missed dose and follow your regular schedule. Inform your doctor if your condition gets worse or does not improve.

What are the side effects of Penicillamine?

Common side effects:

  • Nausea
  • Stomach or abdominal pain
  • Vomiting
  • Diarrhea
  • Loss of appetite
  • Decreased sense of taste
  • Ringing in the ears
  • Itching or rash
  • Sores in the mouth
  • Poor wound healing
  • Increased wrinkling of the skin

Call your doctor if these serious side effects occur:

  • New or worsening joint pain
  • Muscle weakness in your arms and legs
  • New or worsening cough or fever
  • Trouble breathing
  • Skin rash or peeling
  • Blisters in your mouth
  • Swelling in your hands, feet, or legs
  • Lower back pain, foamy or bloody urine
  • Pain or burning when you urinate

Warnings and Precautions

  • Before taking Penicillamine, tell your doctor if you are allergic to it. This may not be recommended for use if you have a history of an allergic reaction. Tell as well if you have any allergies. This drug may contain an inactive ingredient that causes an allergic reaction. 
  • This drug may make you dizzy or drowsy. Alcohol can make you dizzier. Do not use any machinery or do anything that needs your alertness until you can do it safely.
  • Avoid alcoholic beverages.
  • Before starting this treatment, discuss with your doctor about fertility. Your ability to become pregnant or father a child may be affected.
  • Consult your doctor first if you are breastfeeding women.
  • Be sure to tell your doctor if you are taking any other medications such as vitamins or herbal supplements.
  • Keep this drug from heat, moisture, and reach of children.