Penicillamine GPO

Penicillamine GPO





Concise Prescribing Info
Wilson's disease (hepatolenticular degeneration) & chronic lead poisoning.
Dosage/Direction for Use
Wilson's disease Adult 0.75-1.5 g that results in an initial 24-hr cupruresis of over 2 mg should be continued for 3 mth. Max: 2 g/day. Patients who cannot tolerate 1 g/day Initiate w/ 250 mg/day & gradually increase to requisite amount. Childn aged 12-18 yr 0.75-1 g bid. Max: 2 g/day for 1 yr. Usual maintenance dose: 0.75-1 g daily, 1 mth to 12 yr 2.5 mg/kg bid, increased at 1-2 wk intervals to 10 mg/kg bid. Elderly 20 mg/kg daily in divided doses. Pregnant women Max: 500-750 mg daily. Caesarian: Reduce to 250 mg daily for the last 6 wk of pregnancy & post-op until wound healing is complete. Chronic lead poisoning Adult 900-1,500 mg daily in 3 divided doses for 1-2 wk followed by 750 mg/day in divided doses until blood lead levels are reduced to 60 mcg/dL or until urinary lead excretions are <500 mcg/L for 2 consecutive mth. Childn 30-40 mg/kg/day or 600-750 mg/m2/day; may be given as single dose or 2 divided doses. Max: 750 mg/day. Continue treatment until blood lead levels remain <40 mcg/dL for 2 consecutive mth & at least 1 of the following is achieved: Erythrocyte protoporphyrin level decreases to <3-5 times the average normal level, excretion of δ-aminolevulinic acid decreases to upper limit of normal, excretion of coproporphyrin decreases to upper limit of normal. Elderly 20 mg/kg daily in divided doses until urinary lead is stabilised at <0.5 mg/day.
Should be taken on an empty stomach: Take at least 1 hr before or 2 hr after meals, & at least 1 hr apart from any other drug, food or milk. For patients w/ swallowing difficulties, contents of a cap may be administered in 50-30 mL chilled pureed fruit or fruit juice.
Hypersensitivity. History of penicillamine-related aplastic anemia, agranulocytosis or severe thrombocytopenia; RA patients w/ history of evidence of renal insufficiency including renal disease, impairment or failure. Lupus erythematosus. Pregnancy (except in Wilson's disease treatment or cystinuria) & lactation.
Special Precautions
Perform routine urinalysis, white & differential blood cell count, Hb determination & direct platelet count every 2 wk for at least the first 6 mth of therapy & mthly thereafter. Leukopenia & thrombocytopenia. Closely observe for proteinuria &/or hematuria. RA patients who develop moderate degrees of proteinuria may be continued on penicillamine therapy cautiously, provided that quantitative 24-hr urinary protein determinations are obtained at intervals of 1-2 wk. Discontinue in RA patients if unexplained gross hematuria or persistent microscopic hematuria develops. Liver function tests are recommended every 6 mth during therapy in intrahepatic cholestasis & toxic hepatitis; recommended every 3 mth at least during 1st yr of treatment in Wilson's disease. Immediate cessation in the development of abnormal urinary findings associated w/ hemoptysis & pulmonary infiltrates on X-ray. Pulmonary symptoms eg, exertional dyspnea, unexplained cough or wheezing. Neurological symptoms may worsen during initiation of therapy. Various forms of pemphigus may occur during treatment; discontinue if suspected. Therapy should be continued in a daily basis once started for Wilson's disease or cystinuria; temporarily discontinued if drug fever occurs in patients w/ Wilson's disease or cystinuria. Discontinue use if late rash occurs usually ≥6 mth after treatment; drug eruption w/ fever, arthralgia, lymphadenopathy or other allegic manifestations. Hypogeusia may occur. Concomitant use w/ gold therapy, antimalarial or cytotoxic drugs, oxyphenbutazone or phenylbutazone. Allergy to penicillin. Administer pyridoxine (25 mg/day) during therapy in patients w/ Wilson's disease patients; iron deficiency may develop. May cause increased amount of soluble collagen. Avoid in moderate to severe renal failure.
Adverse Reactions
Drug Interactions
Antacids, gold therapy, antimalarials, immunosuppressive (glucocorticoids) or cytotoxic drugs, clozapine, oxyphenbutazone or phenylbutazone. Increased risk of renal damage w/ NSAIDs & other nephrotoxic drugs. May decrease the absorption of digoxin. Decreased absorption w/ Fe & Zn. May increase levels of levodopa. Ethanol. May increase vit B6 excretion.
ATC Classification
M01CC01 - penicillamine ; Belongs to the class of penicillamine and similar antirheumatic agents.
Penicillamine GPO cap 250 mg
10 × 10's
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