What is this medicine?
PENICILLAMINE (pen uh SIL uh meen) binds with heavy metals and cystine in the body. It is used to treat Wilson's disease and cystinuria. It is also used to treat rheumatoid arthritis.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

What side effects may I notice from receiving this medicine?
Side effects that you should report to your doctor or health care professional as soon as possible:

• allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
• black, tarry stools
• breathing problems
• changes in vision
• dark urine
• dizzy, lightheaded
• fever, chills, sore throat
• joint pain
• mouth sores
• numbness, tingling pain
• redness, blistering, peeling or loosening of the skin, including inside the mouth
• swollen or painful glands
• trouble passing urine or change in the amount of urine
• unusual bleeding or bruising
• unusually weak or tired

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

• anxiety, irritation
• changes in taste
• diarrhea
• loss of appetite
• nausea, vomiting
• stomach pain
• wrinkled or loose skin

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

How should I use this medicine?
Take this medicine by mouth with a glass of water. Follow the directions on the prescription label. Take this medicine on an empty stomach, at least 1 hour before or 2 hours after food. Do not take with food. Take this medicine at least one hour apart from milk or other medicines. Take your medicine at regular intervals. Do not take your medicine more often than directed. Do not skip doses or stop your medicine even if you feel better. Skipping doses for even a few days may cause you to have allergic reactions after restarting this medicine. Do not stop taking except on your doctor's advice.

Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.
NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?
If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses.

What may interact with this medicine?
Do not take this medicine with any of the following medications:

• medicines for malaria

This medicine may also interact with the following medications:

• certain antacids that contain aluminum, magnesium
• chemotherapy
• gold compounds used for arthritis
• iron tablets
• multi-vitamins with metals, minerals or iron
• oxyphenbutazone, phenylbutazone

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

Who should NOT use this medication?

• Known or suspected pregnancy except when used for the treatment of Wilson’s disease or in certain individuals with cystinuria. (See Fetal/Neonatal Morbidity and Mortality and Pregnancy under Cautions.)
• Breast-feeding. (See Lactation under Cautions.)
• History of penicillamine-related aplastic anemia or agranulocytosis.
• Rheumatoid arthritis patients with current or history of renal insufficiency.

What should I watch for while using this medicine?
Visit your doctor or health care professional for regular check ups. It may take 2 to 3 months to improve your symptoms. Tell your doctor if your symptoms do not improve or if you get any new symptoms. You will need to have important blood work done while on this medicine.

You may need to be on a special diet while taking this medicine. Check with your doctor. Ask if you need to take extra vitamin B6 or a multi-vitamin while taking this medicine.

If you are taking this medicine to prevent kidney stones you need to drink plenty of water. Drink at least 2 full glasses of water at bedtime and 2 more full glasses of water during the night.

If you are going to have surgery, tell your doctor or health care professional that you are taking this medicine.

What should I tell my health care provider before I take this medicine?
They need to know if you have any of these conditions:

• anemia or other blood disorders
• kidney disease
• myasthenia gravis
• an unusual or allergic reaction to penicillamine, penicillin, other medicines, foods, dyes, or preservatives
• pregnant or trying to get pregnant
• breast-feeding

Can I stop taking the medication if I feel better?
As a general rule, you should always take your medications exactly as prescribed and do not change the dosage or stop taking the medication without first discussing it with your healthcare provider.

I am on so many medications; do I have to take them all?
This is called polypharmacy—many different medications being used at the same time by one person. Sometimes, being on multiple medications is acceptable and appropriate but at other times it may be problematic. If you are receiving your medications from multiple physicians you need to ensure that they all know what medications you are taking. The best way to do this is to make a list of all the medications you are currently using, including all nutritional supplements, homeopathic remedies, vitamins and over-the-counter drugs (if possible, also include all the diseases you have been diagnosed with). Give a copy to every doctor who takes care of you so they have it on file, this way they can avoid duplicating medications and perhaps even try to consolidate some. After every doctor's visit remember to update the list accordingly. Also, as much as you possibly can, try to use the same pharmacy to fill all your prescriptions, this way any potential drug interactions can be caught and averted.