( penicillamine )
125 mg gray / yellow capsule
250 mg yellow capsule
To reduce inflammation and retard
Rheumatoid arthritis and some
other forms of synovitis.
Usually 250 mg ( one tablet or
two 125 mg tablets ) per day for one month, then two tablets ( 500 mg ) a
day for one month, then three tablets ( 750 mg ) per day for one month, and
finally four tablets ( 1,000 mg ) per day. Dosage is usually not increased
rapidly, and may be increased even more slowly than this. After remission,
the drug can be continued indefinitely, usually at a reduced dosage. And if
a good result is obtained earlier, you can stop with the lower dose.
These closely parallel those
noted above for gold injections. The major side effects are skin rash,
protein leakage through the urine, or a decrease in production of the blood
cells. Additionally, individuals may have nausea, and some notice a metallic
taste in their mouth or a decreased sense of taste.
Penicillamine weakens the
connective tissue so that the healing of a cut is delayed, and a scar may
not have the same strength it would have without the penicillamine. So,
stitches following a cut should be left in for a longer period of time, and
wound healing should be expected to be delayed. Surgery under these
circumstances may be more difficult.
Penicillamine takes a number of
months to reach its full therapeutic effect and the effect persists for a
long time after you stop taking the drug. Responses usually take from three
to six months but can be as late as nine months after the drug is begun.
Because o the risk of side effects, doctors have now adopted the "go low, go
slow" approach given in the dosage schedule above. When full doses were
begun earlier, the frequency of side effects was higher. even now, only
about three-quarters of individuals will complete the treatment only about
three-quarters of individuals will complete the treatment and the remainder
will have some side effects, approximately the same as those listed for gold
salts. The drug may be tried again after a side effect if the side effect
has been mild. We do not try the drug again if there has been a problem with
the blood counts, but may cautiously try it if there has been a minor
problem with protein in the urine, a minor skin rash, or minor nausea.
Monitoring for side effects has to be carefully performed. Usually a blood
count or smear, a urinalysis for protein leakage and questioning of the
person about side effects are required every two weeks or even more
frequently. It should be noted that with both penicillamine and gold,
careful monitoring improves your chances of not having a serious side
effect, but does not eliminate them. These drugs contain an intrinsic hazard
that no physician can eliminate. As with gold treatment, you can negotiate
to have some of the drug monitoring done by a local laboratory and review
the results yourself, check your own urine for protein, and so forth, if you
desire. Most doctors who use these drugs a good deal have evolved some
method of minimizing the cost of the monitoring. Again, after the first six
moths, side effects are relatively rare but still do occur. Some individuals
will have an excellent response to the penicillamine even though they never
get up to the full dosage of 1,000 mg per day.