Penicillamine is a chelating (KEE-late-ing) agent that binds to excess copper and removes it from the blood stream. In certain conditions, excess copper can build up in the blood stream, leading to tissue damage throughout the body.

Penicillamine is used to remove excess copper in people with an inherited condition called Wilson's disease.

Penicillamine is also used to reduce urine levels of an amino acid called cystine, which can cause stones to form in the kidneys and bladder in people with an inherited condition called cystinuria.

Penicillamine is also used to treat severe rheumatoid arthritis after other medicines have been tried without success. Penicillamine is not approved to treat juvenile rheumatoid arthritis.

Penicillamine may also be used for purposes not listed in this medication guide.

You should not use penicillamine if you are breast-feeding, if you have ever had an infection or damaged blood cells caused by penicillamine, or if you have kidney disease and you need penicillamine to treat rheumatoid arthritis.

Every person taking penicillamine should remain under the close supervision of a doctor.

Penicillamine comes as a capsule and as a tablet to take by mouth. It is usually taken on an empty stomach at least 1 hour before or 2 hours after a meal, and at least 1 hour before or after any food or milk. For the treatment of Wilson's disease and cystinuria, penicillamine is usually taken four times a day. For the treatment of rheumatoid arthritis it is usually take once a day, but at increased dosages, it may be taken up to four times a day. Your doctor will recommend how long you should receive treatment based on your condition, how well your body responds to the medication, and any side effects that you experience. Take penicillamine at around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take penicillamine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Your doctor will probably start you on a low dose of penicillamine and gradually increase your dose.

For the treatment of Wilson's disease and rheumatoid arthritis it may take one to three months or longer before you feel the full benefit of penicillamine. For all uses continue to take penicillamine even if you feel well. Do not stop taking penicillamine without talking to your doctor, even if your symptoms worsen. If you stop taking penicillamine you are at an increased risk of experiencing an allergic reaction when you start taking the medication again.

Be sure to tell your doctor how you are feeling during your treatment with penicillamine. Your doctor may treat you with other medications, or delay your treatment, reduce your dosage, or stop your treatment depending on the side effects that you experience.

Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.

Take penicillamine on an empty stomach, at least 1 hour before or 2 hours after a meal.

Drink plenty of liquids while you are taking penicillamine.

Do not drink milk within 1 hour before or 1 hour after you take penicillamine.

You will need frequent urine tests.

Your condition may seem to get worse for a short time when you first start taking this medicine. Do not change your doses or medication schedule without your doctor's advice. Every person taking penicillamine should remain under the care of a doctor.

It may take up to 3 months before your rheumatoid arthritis symptoms improve. Keep using the medication as directed and tell your doctor if your symptoms do not improve.

You may need to follow a special diet while using penicillamine. Follow all instructions of your doctor or dietitian. Learn about the foods to eat or avoid to help control your condition.

If you do stop taking penicillamine for any reason, do not start taking it again until you talk to your doctor.

Your doctor may want you to take a multivitamin or take extra iron or vitamin B6 while you are taking penicillamine. Take only the amount of supplements that your doctor has prescribed.

Store at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use.

You should not use penicillamine if you are allergic to it, or if:

• you are breast-feeding;

• you have kidney disease (if using penicillamine to treat rheumatoid arthritis); or

• you have developed an infection or damaged blood cells after taking penicillamine in the past.

Some medicines can cause unwanted or dangerous effects when used with penicillamine. Your doctor may change your treatment plan if you also use:

• gold injections;

• medicine to treat or prevent malaria; or

• cancer medicine.

Tell your doctor if you have ever had:

• kidney disease;

• liver disease;

• an allergy to penicillin;

• a stomach ulcer;

• a weak immune system; or

• if you are malnourished.

Follow your doctor's instructions about taking penicillamine if you are pregnant. Do not start or stop taking penicillamine without your doctor's advice, and tell your doctor right away if you become pregnant.

• Penicillamine may cause harm to an unborn baby and should not be used to treat cystinuria or rheumatoid arthritis if you are pregnant.

• Penicillamine may be used during pregnancy to prevent a relapse of Wilson's disease. Not treating this condition during pregnancy can cause harmful or fatal effects on the mother. The benefit of preventing a relapse of Wilson's disease may outweigh any risks to the baby.

You should not breast-feed while using this medicine.

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

If you are being treated for Wilson's disease your doctor will probably recommend a special diet for you that is low in copper. This diet avoids cereals and dietary supplements that are enriched with copper, chocolate, nuts, shellfish, mushrooms, liver, molasses, broccoli, and other high copper containing foods. Your doctor may also recommend that you drink distilled or demineralized water, instead of regular tap water. Be sure to follow all dietary recommendations made by your doctor.

If you are being treated for cystinuria your doctor may recommend a special diet for you that is low in methionine (a type of protein). However if you are a child or if you are pregnant your doctor may not recommend this diet. Your doctor will also probably recommend that you drink enough liquids.

If you are being treated for rheumatoid arthritis, continue your normal diet unless your doctor tells you otherwise.

Avoid taking other medicines at the same time you take penicillamine. If you take an iron supplement, take it at least 2 hours before or 2 hours after you take penicillamine. Iron can make it harder for your body to absorb penicillamine.

Avoid taking mineral supplements, unless your doctor tells you to.

If you have Wilson's disease, avoid eating nuts, chocolate, molasses, liver, shellfish, mushrooms, broccoli, and cereals that are fortified with copper. Also avoid taking mineral supplements that contain copper. If your drinking water supply contains more than 0.1 mg of copper per liter, you may need to drink distilled or demineralized water.

Get emergency medical help if you have signs of an allergic reaction: hives, rash; swollen glands; difficult breathing; swelling of your face, lips, tongue, or throat.

Penicillamine may cause serious side effects. Call your doctor at once if you have:

• new or worsening joint pain;

• muscle weakness in your arms and legs;

• muscle weakness in your face, drooping eyelids, double vision, trouble chewing or swallowing;

• new or worsening cough, fever, trouble breathing;

• blisters or ulcers in your mouth, red or swollen gums, trouble swallowing;

• skin rash, peeling, or watery blisters;

• pain or burning when you urinate, foamy or bloody urine, lower back pain;

• swelling in your hands, legs, and feet; or

• low blood cell counts--fever, chills, tiredness, skin sores, easy bruising, unusual bleeding, pale skin, cold hands and feet, feeling light-headed or short of breath.

Common side effects of penicillamine may include:

• decreased sense of taste;

• skin changes such as wrinkling or pimples;

• stomach pain, nausea, vomiting, diarrhea, loss of appetite;

• numbness or tingly feeling;

• ringing in your ears; or

• a wound that will not heal.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Other drugs may affect penicillamine, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all your current medicines and any medicine you start or stop using.

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to penicillamine.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.