Penicillamine

It is a metabolite of penicillin although it has no antibiotic properties. The pharmceutical form is D-penicillamine as L-penicillamine is toxic.

Indications

• Used as immunosuppressant in rheumatid arthritis. It works by reducing the number of T-lymphocytes, inhibiting macrophage function, decreasing IL-1 and preventing collagen from cross linking.
• It is used as chelating agent
• Used in wilson disease as it binds copper and enhance its elimination through urine.
• Also used in mercury poisoning

• Wilson's Disease

• 250 mg PO QID; dosage range 500-1500 mg/day

• Arsenic Poisoning

• 100 mg/kg/day PO divided q6hr x5 days

• Rheumatoid Arthritis

• Initial: 125-250 mg/day PO
• Maintenance: May be increased by 125-250 mg/day q1-3Months up to 500-750 mg/day, may be increased further if no response and patient tolerates

• Lead Poisoning

• 1-1.5 g qDay PO or divided BID-TID x1-6 months