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What you need to know before you take Penicillamine

Your doctor will ask you to have blood tests to check your blood count and kidney function before you start taking Penicillamine. He or she will test your blood and urine regularly while you are taking Penicillamine. This is so that your doctor can check for any side effects and adjust your dose if necessary. Do not take Penicillamine: – if you are allergic to penicillamine or any of the other ingredients of this medicine (listed in section 6) – if you have ever had agranulocytosis (reduction in the number of white blood cells) after taking penicillamine – if you have ever had aplastic anaemia (a severe reduction in blood cells which can cause weakness, bruising or make infections more likely) after taking penicillamine – if you have ever had lupus erythematosus (LE), an allergic condition which causes skin rashes – if you suffer from kidney problems – if you have thrombocytopenia (a blood disorder which causes bleeding into your skin, bruising and more bleeding than usual after an injury) after taking penicillamine. If any of the above applies to you, or if you are not sure, talk to your doctor or pharmacist before you take Penicillamine. Warnings and precautions Talk to your doctor or pharmacist before taking Penicillamine, particularly if any of the following applies to you: – if you have ever had side effects with gold or you are currently taking medicines that contain gold – if you have protein in your urine – if you are pregnant, trying to become pregnant or breast-feeding – if you have blood in your urine – if you have leucopenia (a blood disorder which causes susceptibility to infection) – if you are elderly. Your doctor should carry out full blood and urine tests: – weekly or fortnightly for the first 8 weeks of treatment, and then monthly – whenever your dose of penicillamine is increased. If you are taking Penicillamine for Wilson’s disease or for cystinuria, your doctor may carry out these tests at less regular intervals. Your doctor may tell you to stop taking Penicillamine if: – your thrombocyte count or your white blood cell count fall below certain levels, or – either count falls for three tests in a row. If, after stopping your tablets your blood cell counts return to normal, you may be able to restart treatment at a lower dose. If, after restarting your tablets at a lower dose you develop low blood counts again, you should permanently stop taking this medicine. Other medicines and Penicillamine Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. Penicillamine may increase the risk of side effects if you also take the following medicines: – gold (used to treat rheumatoid arthritis) – NSAIDs (non-steroidal anti-inflammatory drugs) e.g. ibuprofen or naproxen (used to treat arthritis and for pain relief) as there is an increased risk of damaging your kidneys – clozapine (used to treat schizophrenia) as taking Penicillamine with clozapine may increase the potential side effects on the bone marrow. The effectiveness of Penicillamine may be altered if you also take the following medicines: – iron therapy (used to treat low iron levels or anaemia). Take the iron at least two hours before or after taking Penicillamine – antacids (used to neutralise acid in your stomach). Take the antacids at least two hours before or after taking Penicillamine – zinc (used to treat low zinc levels), concomitant use may reduce the effect of both medicine. Penicillamine may affect how well the following medicines work: – digoxin (used for an irregular heartbeat). Your doctor may give you pyridoxine (vitamin B6) if you are taking Penicillamine long term, especially if you are on restricted diet. Penicillamine with food and drink Penicillamine should be taken on an empty stomach, and at least half an hour (one hour for children with Wilson’s disease or cystinuria) before a meal, with a drink of water. Pregnancy and breast-feeding You should not take Penicillamine if you are pregnant. Penicillamine may reach your baby through the breast milk. Therefore, you should not take Penicillamine if you are breast-feeding. If your doctor considers that treatment is absolutely essential, he may tell you to take Penicillamine even when you are pregnant or breast-feeding. This will depend on your condition and the disease you have. If you are pregnant or breast feeding, think you may be pregnant or are planning to have baby, ask your doctor or pharmacist for advice before taking this medicine. Driving and using machines Penicillamine is not known to affect your ability to drive or use machines. Penicillamine contains lactose and sodium If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicine. This medicine contains less than 1 mmol sodium (23 mg) per tablet, that is to say essentially ‘sodiumfree’.