m (Changed protection level for "Penicillamine" ([Edit=Allow only autoconfirmed users] (expires 15:08, 18 June 2014 (UTC)) [Move=Allow only autoconfirmed users] (expires 15:08, 18 June 2014 (UTC))))
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'''Penicillamine''' is a [[pharmaceutical]] of the [[Chelation_therapy|chelator]] class. It is sold under the trade names of '''Cuprimine''' and '''Depen'''. The pharmaceutical form is ''D''-penicillamine, as ''L''-penicillamine is toxic (it inhibits the action of [[pyridoxine]]). It is a [[metabolite]] of [[penicillin]], although it has no [[antibiotic]] properties.
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==Uses==
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Penicillamine is used as a form of [[immunosuppression]] to treat [[rheumatoid arthritis]]. It works by reducing numbers of [[T cell|T-lymphocyte]]s, inhibiting [[macrophage]] function, decreasing [[IL-1]], decreasing [[rheumatoid factor]], and preventing [[collagen]] from cross-linking.
Penicillamine is also used for treatment of [[scleroderma]].
It is used as a [[chelating agent]]:
* In [[Wilson's disease]], a rare genetic disorder of [[copper]] metabolism, penicillamine treatment relies on its binding to accumulated copper and elimination through [[urine]].
* In [[cystinuria]], a hereditary disorder featuring increased [[cystine]] excretion, penicillamine binds with the cystine to make it more [[soluble]].
* Penicillamine has been used to treat mercury poisoning.
==History==
Dr John Walshe (1956) first described the use of penicillamine in Wilson's disease. He had discovered the compound in the urine of patients (including himself) who had taken [[penicillin]], and experimentally confirmed that it increased urinary copper excretion by [[chelation]]. He had initial difficulty convincing several world experts of the time (Drs Denny Brown and Cumings) of its efficacy, as they held that Wilson's disease was not primarily a problem of copper homeostasis but of amino acid metabolism, and that [[dimercaprol]] should be used as a chelator. Later studies confirmed both the copper-centered theory and the efficacy of ''D''-penicillamine. Walshe also pioneered other chelators in Wilson's such as [[triethylene tetramine]] 2HCl and [[tetrathiomolybdate]] (Walshe 2003).
==References==
* Walshe JM. ''Penicillamine, a new oral therapy for wilson's disease.'' Am J Med. 1956;21:487-95. PMID 13362281.
* Walshe JM. ''The story of penicillamine: a difficult birth.'' Mov Disord 2003;18:853-9. PMID 12889074.
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Black Box Warning
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Overview
Penicillamine is a {{{drugClass}}} that is FDA approved for the {{{indicationType}}} of {{{indication}}}. There is a Black Box Warning for this drug as shown here. Common adverse reactions include .
Adult Indications and Dosage
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Guideline-Supported Use
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There is limited information regarding Off-Label Guideline-Supported Use of Penicillamine in adult patients.
Non–Guideline-Supported Use
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There is limited information regarding Off-Label Non–Guideline-Supported Use of Penicillamine in adult patients.
Pediatric Indications and Dosage
FDA-Labeled Indications and Dosage (Pediatric)
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There is limited information regarding FDA-Labeled Use of Penicillamine in pediatric patients.
Off-Label Use and Dosage (Pediatric)
Guideline-Supported Use
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Developed by:
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There is limited information regarding Off-Label Guideline-Supported Use of Penicillamine in pediatric patients.
Non–Guideline-Supported Use
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There is limited information regarding Off-Label Non–Guideline-Supported Use of Penicillamine in pediatric patients.
Contraindications
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See full prescribing information for complete Boxed Warning.
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Content
Description
Precautions
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Adverse Reactions
Clinical Trials Experience
There is limited information regarding Clinical Trial Experience of Penicillamine in the drug label.
Body as a Whole
Cardiovascular
Digestive
Endocrine
Hematologic and Lymphatic
Metabolic and Nutritional
Musculoskeletal
Neurologic
Respiratory
Skin and Hypersensitivy Reactions
Special Senses
Urogenital
Miscellaneous
Postmarketing Experience
There is limited information regarding Postmarketing Experience of Penicillamine in the drug label.
