Cuprimine, Depen
Generic available: no
Cuprimine capsule size: 125 mg, 250 mg
Depen (scored) tablet size: 250 mg
Usual dose: two to four pills daily
Effective within: two to nine months
Penicillamine has been used since the 1960s to treat people with RA, and it is quite effective. It is particularly useful in treating a rare complication of RA known as vasculitis. Penicillamine takes a long time to become effective because its dose has to be increased very slowly to minimize side effects.
The chemical structure of penicillamine is similar to that of penicillin. Nevertheless, there seems to be no increased incidence of allergic reactions to this drug in individuals who are allergic to penicillin.
Side effects of penicillamine. Penicillamine therapy produces numerous side effects, which limits its use. Withdrawal rates of up to 40 percent in the first year have been reported. Some of the serious side effects are similar to those of injectable gold. A chief concern is the development of blood abnormalities, the most common being decreased platelet counts, a condition that is usually reversible (approximately 4 percent of people taking penicillamine develop this condition). The white blood cell count decreases in approximately 2 percent of individuals using this drug. Low white blood cell counts are usually reversible, but the risk of infection is increased while the counts are low.
Kidney problems can develop with penicillamine treatment. Almost all of these problems can be reversed if they are detected early. Penicillamine therapy also can, rarely, result in the development of autoimmune conditions such as myasthenia gravis, pemphigus, Goodpasture’s syndrome, or systemic lupus erythematosus. All of these conditions are serious but can be treated successfully.
Before starting penicillamine therapy discuss the following with your physician:
•      A diagnosis of lupus.
•      A history of lung conditions, skin conditions, or kidney or liver disease.
While taking penicillamine:
•     Contact your physician promptly if you notice a new rash or itching, mouth sores, increased bruising, easy bleeding, fever, sore throat, cough, shortness of breath, or a change in urine or skin color.
•      Take medication on an empty stomach (at least one hour before or two hours after a meal).
•       Complete blood counts and urine studies need to be performed frequently during therapy.
Pregnancy and breastfeeding. Since penicillamine can cause birth defects, this medication is not to be taken during pregnancy. Nursing mothers should not take this medication.
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