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Updated November 2019
D-Penicillamine, usually referred to as penicillamine, (brand name: D-Penamine) is a medicine used to treat rheumatoid arthritis. Occasionally it is used to treat other rheumatic diseases such as scleroderma.
Penicillamine should not be confused with the antibiotic penicillin, which is a different compound. Those who are allergic to penicillin may not necessarily be sensitive to penicillamine.
Penicillamine is an immunosuppressive medicine, which means that it works by reducing the activity of the immune system.
In rheumatoid arthritis this action helps to reduce inflammation and thus reduce pain and swelling. It also limits damage to the joints and helps to prevent disability in the long term. Because penicillamine reduces the damage to the joints, rather than just relieving the pain, it belongs to the group of medicines called disease modifying antirheumatic drugs (DMARDS).
Penicillamine does not work straight away. Reduced pain, stiffness and swelling may not be noticed for several months. The full effect may take up to 26 weeks. Other medicines may be given to improve your symptoms while waiting for penicillamine to work.
If you stop your penicillamine treatment for more than a few weeks there is a risk that your condition may worsen.
Treatment with penicillamine may be continued indefinitely as long as it is effective and no serious side effects occur.
Penicillamine is taken by mouth in tablet form usually once or twice a day.
Treatment begins with a small dose (usually 125mg or 250 mg a day) and is increased slowly if there are no side effects in the first few weeks of treatment.
Generally the maintenance dose of penicillamine is between 125mg to 750mg a day depending on the response.
If you miss a dose take it as soon as you remember, but if you remember when it is almost time for your next dose take only the usual dose. Do not take a double dose.
Because the medicine binds to various foods it is important to take it on an empty stomach or at least 1 hour before, or 2 hours after, a meal.
It is also important not to take iron tablets, calcium, milk or antacids within 2 hours of taking penicillamine as they reduce the absorption of the medicine.
Penicillamine may be used with other arthritis medicines including:
You might experience side effects with your treatment. Tell your doctor if you are concerned about possible side effects. A reduction in the dose may minimise side effects so that you can continue to take this treatment. Your doctor will advise on any dose changes that are necessary.
There are some rare but potentially serious side effects with penicillamine.
Use in pregnancy and breastfeeding