Home Drug Guide Penicillamine

Drug Guide

Generic Name

Penicillamine

Brand Names Cuprimine, Depen, Luxzyla

Classification

Therapeutic: Antirheumatic, Chelating agent

Pharmacological: D-penicillamine, a thiol compound

FDA Approved Indications

  • Rheumatoid arthritis (especially severe cases)
  • Wilson's disease (copper overload)
  • Cystinuria (to prevent kidney stones)

Mechanism of Action

Penicillamine chelates heavy metals like copper, leading to their excretion. It also modulates immune responses in rheumatoid arthritis by affecting immune complex formation and leukocyte function.

Dosage and Administration

Adult: Dependent on condition; typically, 250-1000 mg/day divided doses for Wilson's disease and rheumatoid arthritis.

Pediatric: Dosage determined by weight and condition; consult specific guidelines.

Geriatric: Adjusted carefully due to potential adverse effects.

Renal Impairment: Lower doses often required; monitor closely.

Hepatic Impairment: Use with caution; adjust doses as needed.

Pharmacokinetics

Absorption: Well-absorbed orally

Distribution: Widely distributed in body tissues

Metabolism: Minimal hepatic metabolism

Excretion: Excreted primarily unchanged in urine

Half Life: Approximately 1-2 hours, but varies depending on tissue binding and condition

Contraindications

  • History of hypersensitivity to penicillamine or penicillins
  • Severe leukopenia or thrombocytopenia
  • Lupus erythematosus

Precautions

  • Monitor blood counts regularly, especially at initiation.
  • Use with caution in pregnant or breastfeeding women; benefits should outweigh risks.

Adverse Reactions - Common

  • Rash, pruritus (Common)
  • Nausea, vomiting (Common)
  • Proteinuria (Common)

Adverse Reactions - Serious

  • Bone marrow suppression (leukopenia, thrombocytopenia, aplastic anemia) (Rare but serious)
  • Nephritis (Rare)
  • Myasthenia gravis exacerbation (Rare)

Drug-Drug Interactions

  • D-penicillamine can increase serum levels of penicillins, causing toxicity.
  • Concurrent use with Gold compounds may increase risk of adverse effects.

Drug-Food Interactions

  • Supplements containing amino acids or minerals may interfere with absorption.

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Baseline and periodic blood counts, renal function, urinalysis, and neurological assessments.

Diagnoses:

  • Risk of infection due to bone marrow suppression
  • Risk of renal impairment

Implementation: Administer on an empty stomach if possible, monitor lab values regularly, educate about signs of adverse effects.

Evaluation: Efficacy in reducing copper levels in Wilson's disease, improved symptoms in rheumatoid arthritis, and prevention of cystine stones.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Report signs of bleeding, sore throat, fever, or unusual fatigue.
  • Attend regular blood tests as scheduled.
  • Use adequate sun protection due to photosensitivity.

Special Considerations

Black Box Warnings:

  • Potential for severe blood dyscrasias, including aplastic anemia and agranulocytosis.
  • Renal toxicity.

Genetic Factors: Individuals with hepatic cirrhosis are at increased risk for adverse effects.

Lab Test Interference: Can interfere with urine tests for proteins and glucose.

Overdose Management

Signs/Symptoms: Nausea, vomiting, diarrhea, hypotension, shock, and hematological abnormalities.

Treatment: Supportive care; consider chelation therapy with EDTA or penicillamine, and urgent medical consultation.

Storage and Handling

Storage: Store at room temperature, protected from light and moisture.

Stability: Stable under recommended storage conditions.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.