Summary

Commonly reported side effects of penicillamine include: cheilosis, epigastric pain, glossitis, oral mucosa ulcer, ageusia, and dysgeusia. Other side effects include: thrombocytopenia. Continue reading for a comprehensive list of adverse effects.

Applies to penicillamine: oral capsule, oral tablet.

Serious side effects of Penicillamine

Along with its needed effects, penicillamine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur while taking penicillamine:

More common

• Fever
• joint pain
• lesions on the face, neck, scalp, and/or trunk
• skin rash, hives, or itching
• swollen and/or painful glands
• ulcers, sores, or white spots on lips or in mouth

Less common

• Bloody or cloudy urine
• shortness of breath, troubled breathing, tightness in chest, or wheezing
• sore throat and fever with or without chills
• swelling of face, feet, or lower legs
• unusual bleeding or bruising
• unusual tiredness or weakness
• weight gain

Rare

• Abdominal or stomach pain (severe)
• blisters on skin
• bloody or black, tarry stools
• chest pain
• coughing or hoarseness
• dark urine
• difficulty in breathing, chewing, talking, or swallowing
• eye pain, blurred or double vision, or any change in vision
• general feeling of discomfort or illness or weakness
• lower back or side pain
• muscle weakness
• painful or difficult urination
• pale stools
• pinpoint red spots on skin
• redness, tenderness, itching, burning, or peeling of skin
• red or irritated eyes
• red, thick, or scaly skin
• ringing or buzzing in the ears
• spitting blood
• yellow eyes or skin

Other side effects of Penicillamine

Some side effects of penicillamine may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

• Diarrhea
• lessening or loss of sense of taste
• loss of appetite
• nausea or vomiting
• stomach pain (mild)

For Healthcare Professionals

Applies to penicillamine: oral capsule, oral tablet.

Nervous system

Very common (10% or more): Blunting, diminution, or total loss of taste (12%)

Frequency not reported: Headache, dizziness, deterioration of neurological symptoms of Wilson's disease (dystonia, rigidity, tremor, dysarthria) following introduction of therapy in patients treated for this condition (this may be a consequence of mobilization and redistribution of copper from the liver to the brain), arthralgia, tinnitus, peripheral sensory and motor neuropathies (including polyradiculoneuropathy, i.e., Guillain-Barre Syndrome)^[Ref]

Gastrointestinal

Very common (10% or more): Epigastric pain (17%), nausea (17%), vomiting (17%), diarrhea (17%)

Rare (0.01% to 0.1%): Mouth ulceration, stomatitis, glossitis

Frequency not reported: Pancreatitis, reactivated peptic ulcer^[Ref]

Hematologic

Common (1% to 10%): Thrombocytopenia, leukopenia

Frequency not reported: Neutropenia (usually reversible), agranulocytosis (sometimes fatal), aplastic anemia (sometimes fatal), hemolytic anemia, lymphadenopathy, thrombotic thrombocytopenic purpura, red cell aplasia, monocytosis, leukocytosis, eosinophilia, thrombocytosis^[Ref]

Renal

Common (1% to 10%): Proteinuria

Rare (less than 0.1%): Hematuria, renal vasculitis

Frequency not reported: Nephrotic syndrome, glomerulonephritis, Goodpasture's syndrome^[Ref]

Musculoskeletal

Rare (less than 0.1%): Polymyositis, dermatomyositis

Frequency not reported: Lupus erythematosus, myasthenia gravis, rheumatoid arthritis, septic arthritis (in patients with rheumatoid arthritis), muscular weakness^[Ref]

Dermatologic

Common (1% to 10%): Rash (early and/or later in therapy), pruritus

Rare (less than 0.1%): Alopecia, pseudoxanthoma elasticum, elastosis perforans, skin laxity, lichen planus

Frequency not reported: Urticaria, epidermolysis bullosa, exfoliative dermatitis, dermopathy, dermatomyositis, pemphigus, Stevens-Johnson syndrome^[Ref]

Respiratory

Rare (less than 0.1%): Bronchial asthma

Frequency not reported: Pulmonary hemorrhage, dyspnea, pleural effusion, alveolitis, pulmonary fibrosis, bronchiolitis, pneumonitis^[Ref]

Other

Frequency not reported: Deafness, fever, the chelating action of the drug may cause increased excretion of other heavy metals (in addition to copper) such as zinc, mercury, and lead^[Ref]

Genitourinary

Rare (less than 0.1%): Breast enlargement^[Ref]

Hepatic

Rare (less than 0.1%): Intrahepatic cholestasis, toxic hepatitis

Frequency not reported: Cholestatic jaundice, hepatic dysfunction, pancreatitis, increased serum alkaline phosphatase, increased lactic dehydrogenase, positive cephalin flocculation test, positive thymol turbidity test^[Ref]

Ocular

Frequency not reported: Abnormal vision, optic neuritis^[Ref]

Cardiovascular

Rare (less than 0.1%): Thrombophlebitis^[Ref]

Endocrine

Very rare (less than 0.01%): Thyroiditis^[Ref]

General

Both the frequency and severity of many side effects are dose related and vary according to the disease being treated. Initiating therapy at lower doses and titrating up helps to attenuate some side effects.^[Ref]

Hypersensitivity

Rare (less than 0.1%): Allergic reactions including hypersensitivity^[Ref]

Psychiatric

Frequency not reported: Confusion^[Ref]