Penicillamine

Details About Generic Salt ::  Penicillamine 

Main Medicine Class:: #N/A   Sub Medicine Class ::  #N/A

12D. ANTI-RHEUMATIC DRUGS (DMARDS) in 12. MUSCULOSKELETAL DISORDERS & PAIN
PENICILLAMINE
CHELATING AGENT | ANTI-RHEUMATIC, ANTIDOTE
also comes under 21A. Toxicity and Poison Management (Antidotes) in 21. Toxicity and Poison Management (Antidotes)
PK: A: Rapid but variably absorbed M: Hepatic E: Urine

Indications & Dose: CYSTINURIA PO Adult 1–3g/day in divided doses, adjusted to maintain urinary cysteine below 200mg/L; 0.5–1 g in prophylactic therapy Child Minimum dose to maintain urinary cystine below 200mg/L Elderly Same as child dose | RHEUMATOID ARTHRITIS PO Adult Initially 125–250mg/day 1 month, increase by similar amounts at intervals of not less than 4 wk to MD 500–750mg/day in divided doses max 1.5g/day Child 8–12 yr: Initially 2.5–5mg/kg/day gradually increase to MD 15–20mg/kg/day at intervals of 4 wk over period of 3–6 month Elderly Initially up to 125mg/day 1 month, increase at intervals of not less than 4 wk max 1g/day | WILSON’S DISEASE PO Adult 1.5–2g/day in divided doses, max 2g/day 1 yr, MD 0.75–1g/day Child Up to 20mg/kg/day in divided doses or minimum 500mg/day Elderly 20mg/kg/day in divided doses, adjust according to response

Contra: Hypersensitivity, renal insufficiency, history of penicillamine-induced agranulocytosis, aplastic anaemia/severe thrombocytopenia, patients with lupus erythematosus, moderate-to-severe renal impairment

Precautions: Mild renal impairment, hematopoietic-depressant drugs, cystinuria, concomitant nephrotoxic drugs, avoid oral iron within 2h of dose, wilson’s disease, elderly

ADR: Serious: Hypoglycemia, thyroiditis, vasculitis, hepatic failure, intrahepatic cholestasis, toxic hepatitis, increased alkaline phosphatase, thrombophlebitis, myasthenia gravis, polyarthralgia, neuropathies, Goodpasture’s syndrome, renal failure, nephrotic syndrome, renal vasculitis, proteinuria, blood disorders, SJS, proteinuria, Others: optic neuritis, ptosis, visual disturbances, anxiety, agitation, fever, hyperpyrexia, psychiatric disturbances, worsening neurologic symptoms, dystonia, muscle weakness, polymyositis, anorexia, diarrhea, epigastric pain, gingivostomatitis, glossitis, pancreatitis, peptic ulcer reactivation, taste alteration, nausea, vomiting, lupus erythematosus

DDI: Serious Hydroxy chloroquine/Chloroquine increases drug levels, Gold increases risk of adverse effects, NSAIDs increases risk of renal damage, Corticosteroids/Cimetidine leads to breast enlargement (women), Azathioprine/ACEIs leads to myelosuppression, Levodopa levels raised, Digoxin levels reduced, Iron compounds/Antacids reduces drug absorption

Diet: 1h before food

Monitor: Urinalysis, CBC, platelet count, skin, lymph nodes & body temp, LFTs, urinary cystine, annual X-ray for renal stones, serum lead level, Hb, iron status, free erythrocyte protoporphyrin or zinc protoporphyrin, neuro developmental changes, serum non-ceruloplasmin bound copper, periodic ophthalmic exam, proteinuria & hematuria

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