A disease-modifying antirheumatic drug (DMARD)
Penicillamine
An older DMARD used for rheumatoid arthritis and to remove excess copper in Wilson's disease, with close blood and urine monitoring.
What is Penicillamine?
Penicillamine is an older disease-modifying antirheumatic drug (DMARD) used for rheumatoid arthritis when other treatments are unsuitable, and to remove excess copper from the body in Wilson's disease. It works slowly, so it can take weeks or months to help joint symptoms. It can cause a wide range of side effects, including effects on the blood counts, the kidneys and the skin, so regular blood and urine tests are essential. It is started at a low level and built up gradually, and it should be taken on an empty stomach, away from food, iron, antacids and zinc, which reduce its absorption.
Education and reference only. This is a plain-language guide to Penicillamine — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Penicillamine is an older disease-modifying medicine that can slow the joint damage of rheumatoid arthritis and can bind to and remove excess copper in Wilson's disease, an inherited condition where copper builds up. It is also sometimes used to remove certain heavy metals and in a kidney-stone condition called cystinuria. It is taken as tablets by mouth. Because it has many possible side effects, it is now used less often for arthritis and always under careful monitoring.
How it works
In rheumatoid arthritis, penicillamine acts on the immune system over time to reduce the inflammation that damages joints, though exactly how it does this is not fully understood; it works slowly, so benefit builds over weeks to months. In Wilson's disease it binds to copper and helps the body remove it in the urine, lowering the harmful build-up. Because it can affect the bone marrow, kidneys and skin, regular blood and urine tests are needed to catch problems early.
Company & origin
Originated / developed by: Generic (long-established).
An older disease-modifying medicine used in the UK for rheumatoid arthritis and to remove excess copper in Wilson's disease.
What it treats
Conditions Penicillamine is used for
Practical use
How to take Penicillamine
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take it on an empty stomach, usually before food, to help your body absorb it properly.
- Separate it by a couple of hours from food, milk, iron, zinc and antacids, which reduce its absorption.
- Expect it to be started at a low level and built up gradually, and to take weeks to months to help joint symptoms.
- Attend all your blood and urine tests, which are essential for catching side effects early.
- Report any rash, mouth ulcers, fever, sore throat, unusual bruising, bleeding or frothy urine promptly.
- Never stop it suddenly without advice, and tell every prescriber and pharmacist that you take it.
Weighing it up
Advantages & disadvantages of Penicillamine
Advantages
- Can slow joint damage in rheumatoid arthritis when other treatments are unsuitable.
- An effective way to remove excess copper in Wilson's disease.
- Taken simply as tablets, with the dose tailored gradually to each person.
Disadvantages
- Works slowly, often taking weeks to months to help joint symptoms.
- Has a wide range of possible side effects, including effects on the blood counts, kidneys and skin.
- Needs frequent blood and urine monitoring and must be taken away from food and several supplements.
Practical use
Good to know
Penicillamine works slowly, so it may take a couple of months before joint symptoms improve; it is usually started low and increased gradually to reduce side effects. The list of possible side effects is wide and includes effects on the blood counts, protein loss through the kidneys, rashes, taste changes and, less often, autoimmune-type reactions, which is why regular blood and urine monitoring is essential throughout treatment. It should be taken on an empty stomach, well away from food, milk, iron, zinc and antacids, all of which reduce how much is absorbed. People with a true penicillin allergy may occasionally react to it. It should not be stopped suddenly without advice, and any rash, fever, sore throat, unusual bruising or frothy urine should be reported promptly.
Who should not take it / use with caution
- People with significant kidney problems or certain autoimmune conditions may be unable to take it.
- It is generally avoided in pregnancy and used cautiously in people with a history of blood disorders.
- Those who cannot attend regular blood and urine monitoring are not suitable without arrangements in place.
Monitoring
- Regular full blood count tests to watch for effects on the blood counts.
- Regular urine tests to check for protein loss and effects on the kidneys.
- Ongoing review of the skin, mouth and general response, with side effects reported promptly.
Side effects
- Nausea, loss of appetite, taste changes, rashes and mouth ulcers are common, especially early on.
- Effects on the blood counts and protein loss through the kidneys, which monitoring is designed to catch.
- Less commonly, autoimmune-type reactions affecting the kidneys, muscles, skin or other organs.
Key interactions
- Iron, zinc, antacids and food reduce its absorption, so it must be separated from them in time.
- Combining it with other medicines that affect the blood counts or kidneys needs caution.
- It can reduce the effect of certain other medicines, so tell your prescriber everything you take.
Available as: Tablets taken by mouth.
Answers
Penicillamine: frequently asked questions
How long before penicillamine helps my arthritis?
It works slowly and may take weeks to months to improve joint symptoms, which is why it is built up gradually and given time to work.
Why must I take it on an empty stomach?
Food, milk, iron, zinc and antacids reduce how much penicillamine your body absorbs, so it is taken away from them, usually before food.
Why do I need urine as well as blood tests?
Penicillamine can cause the kidneys to leak protein and can affect the blood counts, so both urine and blood are monitored to catch problems early.
What is it used for besides arthritis?
It is used to remove excess copper in Wilson's disease and sometimes in certain heavy-metal poisonings and a kidney-stone condition called cystinuria.
Can I stop it if I feel well?
No. Stopping suddenly can let your condition return, so never change or stop it without your prescriber's advice.
Authoritative sources
- BNF
- NICE CKS
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