Rheumatology Book

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D-Penicillamine

Aka: D-Penicillamine, Penicillamine
  1. Indications
    1. Rheumatoid Arthritis Third-line DMARD agent
    2. Rheumatoid Nodulosis
    3. Wilson's Disease
  2. Contraindications
    1. Penicillin Allergy
  3. Efficacy
    1. Response in 70% of Rheumatoid Arthritis
    2. Slow response requires 4-6 months
  4. Adverse Effects
    1. Adverse effects are common and require stopping drug
    2. Nausea
    3. Gastrointestinal upset
    4. Rash
    5. Stomatitis
    6. Dysgeusia
    7. Cytopenia (5%)
    8. Proteinuria in membranous nephritis (5-20%)
  5. Dosing: Rheumatoid Arthritis
    1. Start low and increase very slowly
    2. Month 1: 250 mg per day
    3. Month 2: 500 mg per day
    4. Month 3: 750 mg per day
    5. Month 4: 1000 mg per day
    6. Maintenance Dose: 750 to 1000 mg per day
    7. Lowest Effective Dose: 500 mg per day
  6. Dosing: Wilson's Disease
    1. Penicillamine 1 g PO before meals and at bedtime
    2. Keep Serum free copper <2 umol/L (<10 ug/dl)
    3. Continue life-long in Wilson's Disease
  7. Monitoring (2-3 times weekly on starting Penicillamine)
    1. Complete Blood Count
    2. Platelet Count
    3. Urinalysis
    4. Body Temperature
  8. Precautions
    1. Observe for Hypersensitivity Reaction
    2. Treat hypersensitivity with Prednisone if occurs

Penicillamine (C0030817)

Definition (NCI_NCI-GLOSS) A drug that removes copper from the body and is used to treat diseases in which there is an excess of this metal. It is also being studied as a possible angiogenesis inhibitor in brain tumors.
Definition (NCI) A beta dimethyl analog of the amino acid cysteine. As a degradation product of penicillin antibiotics, penicillamine chelates with heavy metals and increases their urinary excretion. Possessing antineoplastic properties, penicillamine induces apoptosis by a p53-mediated mechanism and inhibits angiogenesis by chelating with copper, a cofactor for angiogenesis. (NCI04)
Definition (CSP) beta dimethyl analog of cysteine; USP lists as a chelating agent.
Definition (MSH) 3-Mercapto-D-valine. The most characteristic degradation product of the penicillin antibiotics. It is used as an antirheumatic and as a chelating agent in Wilson's disease.
Definition (PDQ) A beta dimethyl analog of the amino acid cysteine. As a degradation product of penicillin antibiotics, penicillamine chelates with heavy metals and increases their urinary excretion. Possessing antineoplastic properties, penicillamine induces apoptosis by a p53-mediated mechanism and inhibits angiogenesis by chelating with copper, a cofactor for angiogenesis. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=42546&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=42546&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C729" NCI Thesaurus)
Concepts Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116)
MSH D010396
SnomedCT 329465002, 330024005, 387235007, 4219002
English beta,beta Dimethylcysteine, beta,beta-Dimethylcysteine, D 3 Mercaptovaline, D Penicillamine, D-3-Mercaptovaline, D-Penicillamine, Dimethylcysteine, Mercaptovaline, Penicillamine, D-Valine, 3-mercapto-, Penicillamine [metabolic], Penicillamine [musculo-skel], Beta-thiovaline, 3-Mercapto-D-valine, Alpha-amino-beta-methyl-beta-mercaptobutyric Acid, Beta,Beta-dimethylcysteine, D-Mercaptovaline, Depamine, Penicillamine [musculoskeletal use], D penicillamine, D-penicillamine (medication), PENICILLAMINE, Penicillamine [Chemical/Ingredient], d penicillamine, d-penicillamine, penicillAMINE, penicillamine, Penicillamine [metabolic] (product), Penicillamine [musculoskeletal use] (product), .beta.,.beta.-Dimethylcysteine, D-3-mercaptovaline, D-penicillamine, beta, beta-Dimethylcysteine, Penicillamine (product), Penicillamine (substance), Penicillamine [metabolic] (substance), Penicillamine [musculoskeletal use] (substance)
Swedish Penicillamin
Czech penicilamin
Finnish Penisillamiini
Russian MERKAPTOVALIN, PENITSILLAMIN, DIMETILTSISTEIN, ДИМЕТИЛЦИСТЕИН, МЕРКАПТОВАЛИН, ПЕНИЦИЛЛАМИН
Japanese メルカプトバリン, L-ペニシラミン, ペニシラミン, D-ペニシラミン, β,β-ジメチルシステイン, ベータ,ベータ-ジメチルシステイン, ジメチルシステイン
French D-Pénicillamine, bêta-Thiovaline, bêta-Mercaptovaline, Diméthylcystéine, Pénicillamine
Polish Penicylamina, Artamin, Merkaptowalina
Spanish penicilamina (metabólico), penicilamina (uso musculoesquelético) (producto), penicilamina (metabólico) (producto), penicilamina (uso musculoesquelético), D-3-mercaptovalina, D-penicilamina, beta,beta-dimetilcisteína, penicilamina (producto), penicilamina (sustancia), penicilamina, Mercaptovalina, Penicilamina, Dimetilcisteína, betadimetilcisteína beta
German Beta,Beta-Dimethylcystein, Dimethylcystein, Mercaptovalin, Penicillamin
Italian Penicillamina
Portuguese beta,beta-Dimetilcisteína, Dimetilcisteína, Mercaptovalina, Penicilamina
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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