Penicillamine

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PI- Penicillamine

Dose:

Commence at 125mg daily taken when going to bed with water (milk and foodreduces absorbtion).
Increase after 1 month to 250mg if tolerated (metallic taste usually settles).
Maximum dose 500 to 750mg daily.

Important interactions:

Do not use with other myelosuppressive drugs

Monitoring:

Blood: Monthly FBC ESR or plasma viscosity (not mandatory but helps to monitor disease)
Urine: Blood and protein

When to act on results:

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Services Rheumatology

1. If total WCC or absolute neutrophil count falls -
   1. from within normal range to below the lower range value.
   2. for 3 consecutive tests (even within the normal range when absolute value falls by 3 x 10-9 cells cm-2).
2. If platelets fall -
   1. from within normal range to below the lower range value.
   2. for 3 consecutive tests (even within the normal range when absolute value falls by 100x10^-9 cells cm²).
3. Urine -
   If urine shows 1+ of blood or protein ignore and recheck when next due If urine shows 2++ or 3+++ of blood or urine STOP D- penecillamine Check MSSU. Treat infection if present: recheck urine by dipstick and recommence if possible.
4. Skin -
   If individual develops skin reaction stop D-penecillamine until rash settled and then rechallenge. If rash does not settle in 1 month it is most unlikely that the rash was due to the penecillamine.
   It is very reasonable to stop D-penecillamine for 1 month to see the effect on the skin or blood results.
   If there is no effect it is unlikely to be this drug which is causing any abnormality.

Document Information
Expiry Date: 11/04/04
Author: Kennedy Tom Dr
Organisation: Arrowe Park Hospital