This medication is used to treat rheumatoid arthritis, Wilson's disease (a condition in which high levels of copper in the body cause damage to the liver, brain, and other organs), and a certain disorder which causes kidney stones (cystinuria). For the treatment of rheumatoid arthritis, penicillamine is known as a disease-modifying antirheumatic drug (DMARD). It helps to decrease pain/tenderness/swelling in the joints. For the treatment of Wilson's disease, penicillamine binds to copper and helps it to be removed from the body. Decreasing copper levels helps to improve liver function and the mental/mood/nerve problems (such as confusion, difficulty speaking/walking) caused by the disease. For the treatment of cystinuria, penicillamine helps to decrease the amount of a certain substance (cystine) in the urine which can cause kidney stones.

This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional.

This drug may also be used for lead poisoning.

Take this medication by mouth on an empty stomach (1 hour before or 2 hours after meals) as directed by your doctor. Take this medication at least 1 hour apart from any other drug, food, milk, antacid, zinc, or products containing iron. These products may bind with penicillamine, preventing your body from fully absorbing the drug.

The dosage is based on your medical condition and response to treatment.

Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time(s) each day.

For the treatment of rheumatoid arthritis, it may take 2 to 3 months before you see any improvement in your condition.

For the treatment of Wilson's disease, follow the diet recommended by your doctor to get the most benefit from this medication. Your condition may not get better for 1 to 3 months and may actually get worse when you start this medication. Tell your doctor if your condition continues to get worse after a month of treatment.

For the treatment of cystinuria, follow the diet recommended by your doctor to get the most benefit from this medication. Drink plenty of water unless your doctor directs you otherwise.

Tell your doctor if your condition does not get better or if it gets worse.

Stomach/abdominal pain, nausea/vomiting, loss of appetite, diarrhea, and decreased sense of taste may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.

Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if you have any serious side effects, including:

• signs of infection (such as sore throat that doesn't go away, fever, swollen lymph nodes)
• easy bruising/bleeding
• coughing up blood
• shortness of breath
• unusual tiredness
• rapid breathing
• skin blisters
• mouth sores
• new or worsening joint pain
• thinning/wrinkling skin
• signs of kidney problems (such as change in the amount of urine, bloody urine)
• muscle weakness
• eye problems (such as drooping eyelids, blurred vision)
• signs of liver problems (such as nausea/vomiting that doesn't stop, severe stomach/abdominal pain, dark urine, yellowing eyes/skin)

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including:

• rash
• itching/swelling (especially of the face/tongue/throat)
• severe dizziness
• trouble breathing

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US - Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Before taking penicillamine, tell your doctor or pharmacist if you are allergic to it; or to penicillins; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of:

• a previous severe reaction to penicillamine (such as aplastic anemia, agranulocytosis)
• kidney disease
• blood/bone marrow disorders (such as thrombocytopenia)

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Tell your doctor if you are pregnant or plan to become pregnant. You should not become pregnant while using penicillamine. Penicillamine may harm an unborn baby. However, it may sometimes be used during pregnancy in certain situations (such as treating Wilson's disease). If you become pregnant, talk to your doctor right away about the risks and benefits of this medication.

It is unknown if this medication passes into breast milk. Because of the possible risk to the infant, breastfeeding is not recommended while using this medication. Consult your doctor before breastfeeding.

See also How to Use section.

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

Some products that may interact with this drug include:

• digoxin
• gold salts (such as auranofin)
• drugs to treat malaria (such as chloroquine)
• phenylbutazone
• other drugs that decrease bone marrow function (such as azathioprine, cancer chemotherapy, trimethoprim/sulfamethoxazole)

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call 1-800-222-1222. Canada residents can call 1-844-764-7669.

Do not share this medication with others.

Lab and/or medical tests (such as complete blood count, hematocrit/hemoglobin, liver function, urine test, physical exam) should be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.

If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.