Cuprimine

The active ingredient in Cuprimine is penicillamine. The mechanism of action for penicillamine is that it is a chelating agent, which means it binds to heavy metals in the body. It aids your body in eliminating specific toxins that cause Wilson's disease and cystinuria.

• Wilson's disease is a genetic condition that causes copper to accumulate in the liver, brain, and other tissues. Penicillamine clings to copper, allowing your body to eliminate it through your urine. This reduces your risk of developing kidney stones and can help dissolve those that have already formed.
• Cystinuria is a hereditary disease that causes cystine-containing stones to develop in the kidneys and bladder. Penicillamine reduces the amount of cystine in your urine by binding to it and generating a material that your body can eliminate more easily.
• Penicillamine can be used as a disease-modifying antirheumatic drug (DMARD) to treat rheumatoid arthritis. However, it is not effective in the treatment of ankylosing spondylitis (chronic arthritis that affects the spine).

Follow all directions given to you by your doctor and read all documents provided, including the full Prescribing Information, FDA-Approved Product Labeling, Instructions for Use, and Medication Guide, before using Cuprimine. However, the following is a synopsis of the general guidelines for the use of Cuprimine:

• Take Cuprimine on an empty stomach, at least 1 hour before or 2 hours after eating.
• Drink plenty of fluids while on Cuprimine.
• Do not consume milk within 1 hour before or after taking Cuprimine.
• You will require frequent urine tests.
• When you initially start using this medication, your condition may appear to worsen temporarily. Do not change your doses or prescription schedule without consulting your doctor first. Every person using Cuprimine should be under the supervision of a doctor.

The most common side effects of Cuprimine include:

• Loss of appetite.
• Nausea.
• Vomiting.
• Stomach pain.
• Blisters or mouth sores.
• Rash.
• Protein in your urine.

Some individuals may experience serious side effects while using Cuprimine. These side effects may require immediate medical attention. If you experience any of the following, contact your healthcare provider or seek emergency medical help:

• Low platelets (thrombocytopenia) cause bruising and bleeding.
• Kidney disease manifests as blood in your urine.
• Allergic reactions to the medication, such as a skin rash (hives), shortness of breath, and swelling of your face, tongue, or throat.
• Myasthenia gravis, nerve problems, and muscle weakness.
• Aplastic anemia (anemia due to a lack of all blood cells).
• Agranulocytosis (lack of certain white blood cells).

These are not all of the possible side effects associated with the use of penicillamine. You should always seek medical advice from your healthcare provider for any questions or concerns about your medical condition or treatment. Read all patient information, medication guides, or drug information sheets that come with this medication. You can also report adverse effects to the Food and Drug Administration at www.fda.gov/medwatch or 1-800-FDA-1088.

Before starting Cuprimine, it is crucial to discuss any existing health conditions with your healthcare provider. You should be sure that your healthcare provider is aware of all your medical conditions, including whether you have:

• Kidney disease or renal insufficiency.
• Liver disease.
• Developed an infection or damaged blood cells after taking Cuprimine in the past.
• Medicine to treat or prevent malaria.
• Penicillin allergy.
• Stomach ulcer.
• Weak immune system.
• Have anorexia.
• Lupus erythematosus.
• Bone marrow suppression.
• Swollen lymph nodes.

• Currently pregnant (unless you have Wilson's disease or specific cystinuria cases).
• Currently breastfeeding.
• History of blood issues following penicillamine (Depen).
• Have rheumatoid arthritis and kidney issues.

It may take 2 to 3 months for rheumatoid arthritis treatment to show results.

If you have symptomatic Wilson's disease, it may take 2 to 6 months of penicillamine (Depen) medication to observe any improvement.

When Cuprimine is taken with other prescription drugs, over-the-counter medications, vitamins, and supplements, it may change how they work or increase the frequency or severity of side effects. Make sure that you tell your healthcare professional about anything that you are taking to avoid any negative drug interactions, including:

Some items that may interact with this medicine include digoxin, gold salts (such as auranofin), malaria treatments (such as chloroquine), phenylbutazone, and other pharmaceuticals that reduce bone marrow function.

This drug is available as pills and capsules. Take penicillamine (Depen) on an empty stomach, away from certain mineral-containing meals or drugs.

Wilson's Disease

Adults: Your dose is often determined by the amount of copper in your urine and bloodstream. The typical daily dose is between 750 mg and 1,500 mg, divided into two doses. If you are unable to tolerate greater doses, your provider may recommend starting with 250 mg per day and gradually increasing your dose to avoid side effects.

Pediatric patients: Consult your child's provider to determine the right dose.

Cystinuria

Adults: A usual dose is 1 to 4 grams given orally every day, divided into four doses during the day. Start with 250 mg each day. Then, your provider might gradually increase the dose. This allows for better control over how well the medication works and prevents negative effects.

Pediatric patients: The dosage will be determined by your child's weight. The normal dose is 30 mg/kg of weight administered orally four times each day.

Patients with Wilson's disease or cystinuria should be given 25 mg/day of pyridoxine during therapy since penicillamine increases the requirement for this vitamin.

Treatment of rheumatoid arthritis

Adults: The typical starting dose is 125 mg or 250 mg administered orally every day. Depending on how you respond to the drug, your doctor may gradually increase your dose to a common maintenance dose of 500 mg to 700 mg per day. Dosages of more than 500 mg per day should be divided into multiple doses throughout the day.

Children: It is unclear whether penicillamine (Depen) performs well in children with juvenile RA. Consult your child's doctor about alternative drugs.

Adjust the dose to achieve urinary copper excretion of 0.5-1 mg/day.

Store your medication at room temperature and keep it out of reach of children.

Bausch Health is the pharmaceutical company that manufactures Cuprimine.

There are several lower-cost generic versions available.

Do not stop taking it without first consulting your doctor, as discontinuing and then restarting the medication may raise the risk of side effects.

Cuprimine may be harmful to an unborn infant and should not be taken to treat cystinuria or rheumatoid arthritis when pregnant. Cuprimine may sometimes be taken during pregnancy to avoid a return of Wilson's disease. If this illness is not treated during pregnancy, the mother may suffer serious or fatal complications. The benefits of avoiding a relapse of Wilson's illness may exceed the dangers to the newborn.

It is not known if Cuprimine is found in breast milk. However, it is generally not recommended if you are breastfeeding. Talk to your doctor if you are already breastfeeding or if you have any plans to breastfeed. They will know or recommend what is best for you.