What is penicillamine?

Penicillamine is a prescription drug that is available as an oral tablet and oral capsule. It is used to decrease pain, swelling, and tenderness associated with rheumatoid arthritis.

It is also used to remove unwanted substances from the body. For people with Wilson's disease, it removes excess copper. It is also used to remove arsenic in people with arsenic poisoning and to prevent bladder and kidney stones.

The brand names for this drug are Cuprimine and Depen. A generic version is not available.

Penicillamine comes with a boxed warning from the United States Food and Drug Administration (FDA), which says that only doctors who are familiar with this drug and its side effects should use it, because there is a risk of significant adverse effects.

Patients need to stay under the doctor's supervision while using this drug, and a number of tests to monitor for changes will probably be necessary.

It can cause severe kidney damage, and it can affect the body's blood-clotting function, increasing the risk of bleeding. It can also increase the risk of developing an infection.

It should only be prescribed by doctors who are trained to use it. The doctor will monitor the patient closely while using this drug to check for any problems.

Fast facts about penicillamine

• Penicillamine is an oral medication used to treat rheumatoid arthritis, Wilson's disease, cystinuria, and arsenic toxicity

• Common side effects include upset stomach, itching skin or a rash, nausea, loss of taste, stomach pain, not feeling hungry, and diarrhea.

• Lab results may show protein in the urine, low white blood cells, and low platelets.

• It is not suitable for use during pregnancy, while trying to become pregnant, or while breastfeeding.

• It may cause the body to lose vitamin B6, and daily supplements may be needed.

• Those with kidney and bladder stones should drink at least 2 pints of water each day to flush the medicine through the system.

Uses: How it works

Penicillamine is used to treat joint disease, but exactly how it does this is unclear.

It treats kidney and bladder stones, known as cystinuria, by removing a protein called cystine from the body.

It works to treat Wilson's disease by removing excess copper from the body. It also removes arsenic from the body in cases of arsenic poisoning.

Penicillamine is a chelating agent. That means it binds to certain compounds, which helps your body to remove them.

Common side effects

The most common side effects include:

• rash or itchy skin

• a loss of taste

• not feeling hungry

• vomiting

• diarrhea

• bleeding

• fever

• infection

• ulcers or sores in the mouth

• protein in the urine, which can cause kidney failure

• low platelets and low white blood cells

Symptoms and signs of kidney problems may include:

• swelling of the hands, feet, or face

• cloudy or foamy urine

Mild side effects may disappear within a few days or a couple of weeks. If side effects are severe or do not go away, it is important to speak to a doctor.

Serious side effects

Penicillamine has been linked to some life-threatening cases of aplastic anemia, agranulocytosis, thrombocytopenia, Goodpasture's syndrome, and myasthenia gravis.

It is important to be aware of the possible side effects of this and other medications. If you experience any of the following serious side effects, call your doctor right awa

• Allergic reaction

• Infection

• Increased bleeding

• Liver problems

• Kidney problems

• Pancreas problems

Food and drug interactions

Penicillamine can interact with other medications, herbs, vitamins, and other supplements, so it is important to talk to the doctor about any existing medications.

Having all prescriptions filled at the same pharmacy can help reduce this risk, because the pharmacist can check for possible drug interactions.

Food Interactions

Food can decrease the effect of this medication. Penicillamine should be taken on an empty stomach. It can be taken 1 hour before or 2 hours after eating. Some people may have to drink a lot of liquids while taking this medication to maximize the effect. The doctor can advise about this.

Vitamin B6

Using this drug may cause the body to excrete more vitamin B6 than usual. To prevent a deficiency, the doctor may recommend using supplements.

Drug interactions

It needs to be taken at least 1 hour before or after any other medication in order to prevent an interaction. Here are some of the possible drug interactions.

Heart drugs: Digoxin

Penicillamine can cause lower levels of digoxin in your body and reduce its effect. A higher dose of digoxin may be necessary.

Antacids: Aluminum hydroxide and magnesium hydroxide (milk of magnesia)

Antacids can decrease the effect of penicillamine in the body. They should be avoided for one hour before and after taking penicillamine.

Iron pills

These may decrease the effect of penicillamine. Iron pills should not be taken for one hour before or after taking penicillamine.

Malaria drugs

Combining penicillamine with malaria drugs can cause serious side effects.

Cancer drugs

Serious adverse effects can result from taking penicillamine with cancer drugs.

Who should not use penicillamine?

Some people should not use this drug because the side effects can be more severe with certain conditions.

Blood cell disorders

If the body is not making enough white blood cells, penicillamine can make this worse, leading to infections and other serious side effects. The doctor may need to do routine blood tests to monitor the patient's blood cell counts.

Kidney disease

People with moderate or severe kidney disease should not use this drug. Penicillamine is removed from your body by your kidneys. Kidney disease may lead to an increased amount of penicillamine in your body. This could cause increased side effects.


Penicillamine is a category D pregnancy drug. This means: 1. Studies show a risk of adverse effects to the fetus when the mother takes the drug. 2. This drug should only be used during pregnancy in serious cases where it's needed to treat a dangerous condition in the mother. Patients should tell the doctor if they are pregnant, plan to become pregnant, miss a period, or have unprotected sex while taking this medication. Penicillamine can cause harm to a developing fetus.


Penicillamine may pass through breast milk and cause harm to the baby during breast-feeding. Breastfeeding is not recommended while taking penicillamine.


For rheumatoid arthritis and Wilson's disease, the safety and effectiveness of penicillamine have not been established in people younger than 18 years.


Penicillamine can cause a severe allergic reaction in some people. Anyone who has ever had a serious reaction to this drug should not take it again. Doing so could be fatal.


The doctor will decide on the best dose and form of the drug.

This will depend on:

• the person's age

• the condition being treated

• how severe the condition is

• other medical conditions

• reaction to the first dose

An adult with Wilson's disease will probably take between 250 milligrams (mg) and 2,000 mg a day, by capsule.

For cystinuria, the usual adult dose is 2,000 mg per day, but the dose can range from 1,000 to 4,000 mg. For rheumatoid arthritis, the doctor may prescribe between 125 mg and 1,500 mg per day.

It is important to follow the doctor's instructions when taking any medication. If side effects occur, these should be reported to the doctor, who can advise on the next step. Taking too much of this drug can lead to serious side effects, including nausea and vomiting, and possibly liver or kidney problems. If you miss a dose, do not take a double dose next time. You may be able to tell the drug is working if you experience a reduction in your symptoms. Talk to your doctor to see if your medication is working for you. This medication may be taken long term or short term. Talk to your doctor about how long you'll need to take it.

Important Safety Information

“Treatment of patients with Trientine Hydrochloride Capsules may be complicated by severe, sometimes lifethreatening, adverse effects. Trientine Hydrochloride Capsules should be administered under the supervision of a physician experienced in the use of this medication for the treatment of sickle cell anemia.”

“Hydroxyurea is mutagenic and clastogenic, and causes cellular transformation to a tumorigenic phenotype. Hydroxyurea is thus unequivocally genotoxic and a presumed transspecies carcinogen which implies a carcinogenic risk to humans. In patients receiving long-term hydroxyurea for myeloproliferative disorders, such as polycythemia vera and thrombocythemia, secondary leukaemia’s have been reported. It is unknown whether this leukemogenic effect is secondary to hydroxyurea or is associated with the patient's underlying disease. The physician and patient must very carefully consider the potential benefits of Trientine Hydrochloride Capsules relative to the undefined risk of developing secondary malignancies. Trientine Hydrochloride Capsules is used to treat chronic myeloid leukaemia or cervical cancer.”

“Your medical team will discuss with you the options for treating your cancer. They will take into account factors such as the type of cancer, where it is, which stage it is at and whether you have had treatment before. The results of blood tests and other investigations will also be considered. How well you feel and how you are likely to cope with treatment is also important.”

“Your cancer treatment will usually consist of a treatment session with Trientine Hydrochloride Capsules followed by a break of a number of days before the next treatment session with Trientine Hydrochloride Capsules. This cycle may be repeated many times as part of your cancer treatment. Trientine Hydrochloride Capsules works by damaging cancer cells in the body. Trientine Hydrochloride Capsules also affects healthy cells and treatment with Trientine Hydrochloride Capsules may damage your immune system. Your medical team may arrange for you to have some blood tests to check how well your immune system is working. Do not share your medicine with other people. It may not be suitable for them and may harm them. The pharmacy label on your medicine tells you how much medicine you should take. It also tells you how often you should take your medicine. This is the dose that you and your prescriber have agreed you should take. You should not change the dose of your medicine unless you are told to do so by your prescriber. If you feel that the medicine is making you unwell or you do not think it is working, then talk to your prescriber.