Initially 1 g/day, may increase
as indicated by urinary copper analysis; seldom > 2 g/day.
Adult 2 g/day. Range : 104
g/day. Children 30 mg/kg/day. Patient should drink 1 pint of fluid at
bedtime & 1 pint during the night.
Initial 125-250 mg daily,
increase at 1-3 month interval by 125-250 mg/day until remission or signs of
toxicity develop. If no improvement after 304 months of 1000-1500 mg/day,
discontinue. If the patient has been in remission for
≥ 6 months, may gradually reduce dosage by < 125 mg-250 mg/day at
approximately 3 months interval. Dose
≤ 500 mg may be given as single dose, > 500 mg in divided dose.
Pregnancy ( except for Wilson's
disease) & lactation. History of penicillamine-related aplastic anemia or
agranulocytosis. Rheumatoid arthritis (RA) patients with history or evidence
of renal insufficiency.
Use associated with fatalities
due to aplastic anemia, agranulocytosis, thrombopenia, Goodpasture's
syndrome & myasthenia gravis. serious hematological & renal side effects may
occur. Discotinue if proteinuria or hematuria continue. Abnormal urinary
findings associated with hemoptysis & pulmonary infiltrates on X-ray require
immediate cession of penicillamine. If drug fever occurs in patient with
Wilson's disease or cystinuria, penicillamine should be temporarily
discontinue until reaction subsides. discontinue use if drug fever occurs in
RA patients. Sideroblastic anemia, renal vasculitis.
Gastrointestinal (GI) effects,
skin reactions, hematological, central nervous system (CNS) & neuromuscular
effects. Obliterative bronchiolitis (rare). Positive antinuclear antibody
test with or without lupus erythematosus-like syndrome. Iron deficiency.
drug fever renal effects. Increased amount of soluble collagen which
may be the cause of increased skin friability at sties subject to pressure
Avoid use with gold therapy,
antimalarial or cytotoxic drugs, oxyphenbutazone or phenylbutazone.
Cap 250 mg x 100's.