D-Penicillamine Pharmacology

D-Penicillamine

About D-Penicillamine
Chelating agent, Immunosuppressive agent,Thiols derivative, antirheumatic(DMARDs).
Mechanism of Action of D-Penicillamine
D-Penicillamine is a chelating agent. The chelating agents being antagonists compete with body ligands for the heavy metals. They usually have 2 or more reacting groups which can hold the metal from 2 sides to form a ring. These should have higher affinity for the toxic metal to be excreted than Ca 2+ which is readily available in plasma than in body fluids. They should also have higher affinity for the metal than the body ligands.
The SH groups of Dimercaprol bind those metals ( copper, mercury, iron, lead) which produce their toxicity by interacting with sulfhydryl containing enzymes in the body and forms stable soluble complex which can be easily excreted through urine
Cystinuria: Penicillamine (SH groups) reacts with poorly soluble Cysteine and form water soluble Penicillamine-Cysteine mixed disulphide complex
Rheumatoid arthritis: Penicillamine reduces the concentration of rheumatoid factor IgM and depresses T-cell activity
Primary Biliary cirrhosis, Scleroderma: Penicillamine reduces the concentration of immunoglobulin and immune complex
Pharmacokinets of D-Penicillamine
Absorption: D-Penicillamine is well absorbed after oral administration
Metabolism: It is metabolised in the liver to inactive metabolite
Excretion: Drug is excreted in urine and faeces.
Onset of Action for D-Penicillamine
6 -12 weeks
Duration of Action for D-Penicillamine
1- 3 weeks
Half Life of D-Penicillamine
10 hours
Side Effects of D-Penicillamine
1.Headache
2.Nausa
3.Anorexia
4.Vomiting
5.Sore throat
6.Rashes
7.Fever
8.Nausea
9.Lymphadenopathy
10.Oral ulceration
11.Stomatitis
12.Loss of taste
13.Hypogeusia
14.Pruritis
15.Haematuria
16.Proteinuria
17.Lymphadenopathy
18 Ecchymosis (discoloration of the skin)
19.Leucopenia
20.Aplastic anaemia
21 Aggranulocytosis
Contra-indications of D-Penicillamine
1.Hypersensitivity to D-Penicillamine
2.History of Penicillamine related aplastic anaemia or Agranulocytosis
Special Precautions while taking D-Penicillamine
1 Renal impairment
2.Hepatic impairment
3.Patient allergic to Penicillin
4.Proteinuria
Pregnancy Related Information
Contraindicated
Old Age Related Information
Use with caution
Breast Feeding Related Information
Contraindicated
Children Related Information
Use with caution
NEONATES: contraindicated
Indications for D-Penicillamine
1.Wilson`s disease
2.Cystinuria
3.Mercury poisoning (alternative to Dimercaprol)
4.Adjuvant to CaNa2EDTA for chronic lead poisoning
5.Rheumatoid arthritis
6.Primary Biliary cirrhosis
7.Scleroderma
Interactions for D-Penicillamine
MUSCULO-SKELETAL DISORDERS: Gold salts, Antimalarials, Cytotoxic drugs, Oxyphenbutazone and Phenylbutazone: They are associated with similar hematologic and renal toxic reactions.
Iron salts (Ferrous sulphate 35%), Antacids (Aluminium hydroxide, Magnesium hydroxide, simethicone mixture; 66%) and Food (52% to 63%) : Absorption of penicillamine is significantly decreased on concommitant administration.
Digoxin: Serum levels of digoxin decreased requiring increase in its dose.
Typical Dosage for D-Penicillamine
Oral
Adult: 1- 1.5 g/day in 4 divided doses
Heavy metal poisoning: 500 mg 1- 3 times daily for 1 - 2 months
Wilson`s disease: 250 -500 mg 4 times daily 30 - 60 minutes before food.
Cystinuria: 500mg 4 times daily
Rheumatoid arthritis: Initial dose: 125 - 250 mg
Primary Biliary cirrhosis: 250 mg / day followed by 250mg increment in every 2 weeks up to 1 g / day in divided doses.
Children: 20mg/kg/day
Schedule of D-Penicillamine
H
Storage Requirements for D-Penicillamine
Store at room temperature protected from heat and light. Keep out of the reach of children.
Effects of Missed Dosage of D-Penicillamine
Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose. Continue the regular schedule. Do not double the dose.
Effects of Overdose of D-Penicillamine
Give supportive measures and symptomatic treatment. Drug can be removed from the body by gastric lavage or by inducing emesis. Absorption of the drug can be reduced by administration of activated charcoal. Seizure can be controlled by administration of Diazepam. Dialysis can be done in emergency cases.

Home Delivery for D-Penicillamine in Your City

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However, we do publish a comprehensive directory of Pharmacies, Chemists and Druggists in cities all over India. You can use this directory to find the medicine stores in your city (or area) that provide home delivery services for d-penicillamine and other medicines and health products. Home delivery services for d-penicillamine may be free or they may cost you depending on the pharmacy and the minimum order requirements. It would be best to get this clarified while placing the order.

Please be aware that you should take d-penicillamine only if a doctor has recommended or prescribed it. Some or all pharmacies who provide a home delivery service for medicines might insist on a prescription for d-penicillamine before they complete the sale. You can get this information while placing the order for d-penicillamine with the pharmacy.

D-Penicillamine is a generic medicine name and there are several brands available for it. Some of the brands for d-penicillamine might be better known than d-penicillamine itself. If the pharmacy that's willing to deliver medicines to your home doesn't have d-penicillamine in stock, you can ask for one of the branded alternatives for d-penicillamine.