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Indications & Uses
Wilpen is indicated for:
Pharmacology
Penicillamine is a chelating agent, which means it helps remove copper and lead from the body. In vitro studies show that one atom of copper combines with two molecules of penicillamine. On that basis, one gram of penicillamine should be followed by the excretion of about 200 milligrams of copper. The amount actually excreted is only about one percent of this. How lead is chelated is not known, though it may be bound in the same way as copper.
Penicillamine also reduces excess cystine excretion in cystinuria. It does this, at least in part, by disulfide interchange between penicillamine and cystine. This forms penicillamine-cysteine disulfide, which is much more soluble than cystine and is excreted readily.
Penicillamine interferes with the formation of cross-links between tropocollagen molecules, and it cleaves them when they are newly formed. In rheumatoid arthritis, the way penicillamine works is unknown, although it appears to suppress disease activity. Unlike cytotoxic immunosuppressants, it markedly lowers IgM rheumatoid factor but does not significantly depress absolute levels of serum immunoglobulins. Cytotoxic immunosuppressants act on both T-cells and B-cells. Penicillamine, in vitro, depresses T-cell activity but not B-cell activity. In vitro, it also dissociates macroglobulins (rheumatoid factor), but how this relates to its effect in rheumatoid arthritis is not known.
Dosage Reference
Reference Information Only
Dosages shown are general references from official sources. Always consult your doctor or pharmacist for personalized dosing.
Detailed dosing reference is not available yet. Please follow your prescription and consult your pharmacist.
Side Effects
Penicillamine causes unwanted reactions quite often, and some of them can be fatal. For this reason, anyone taking Penicillamine must stay under close medical supervision for the whole time they are on the medicine.
Cautions & Contraindications
Warnings & Precautions
Penicillamine has been linked with deaths from aplastic anemia, agranulocytosis, thrombocytopenia, Goodpasture's syndrome and myasthenia gravis. Serious blood and kidney reactions can appear at any time, so routine urinalysis, a white and differential blood cell count, a hemoglobin test and a direct platelet count must be done every two weeks for at least the first six months of Penicillamine therapy, and monthly after that. Patients should be told to report promptly any signs of granulocytopenia and/or thrombocytopenia, such as fever, sore throat, chills, bruising or bleeding. These laboratory tests should then be repeated promptly. Leukopenia and thrombocytopenia have been reported in up to five percent of patients during Penicillamine therapy. The leukopenia affects the granulocytic series, and it may or may not come with a rise in eosinophils. If a reduction in WBC below 3500 is confirmed, Penicillamine therapy must be stopped. Thrombocytopenia may be idiosyncratic, with decreased or absent megakaryocytes in the marrow, when it is part of an aplastic anemia. In other cases it is presumably immune in origin, since the number of megakaryocytes in the marrow has been reported to be normal or sometimes increased. If the platelet count falls below 100,000, Penicillamine therapy needs to be stopped, at least temporarily, even when there is no clinical bleeding. The same applies when either the platelet count or the WBC falls progressively over three successive determinations, even if the values are still within the normal range.
Contraindications
Penicillamine should not be given to patients who are hypersensitive to the drug or to any ingredient in the formulation. It should also not be used in pregnancy. The exceptions are the treatment of Wilson's disease and certain cases of cystinuria. Although breast milk studies have not been reported in animals or humans, mothers on penicillamine therapy should not nurse their infants. Patients with a history of penicillamine-related aplastic anemia or agranulocytosis should not be restarted on it. Because the drug can cause renal damage, it should not be given to rheumatoid arthritis patients who have a history or other evidence of renal insufficiency. In chronic lead poisoning, penicillamine should not be given when x-ray shows lead-containing substances in the gastrointestinal tract. Treatment may be started once the gastrointestinal tract has been cleared of these substances. Studies in animals suggest that penicillamine may be ineffective, and possibly hazardous, if excessive oral ingestion of lead continues during administration. It should not be used in patients receiving gold therapy, antimalarial or cytotoxic drugs, oxyphenbutazone or phenylbutazone, because these drugs are also associated with similar serious hematologic and renal adverse reactions. Patients who have had gold salt therapy stopped because of a major toxic reaction may be at greater risk of serious adverse reactions with penicillamine, though not necessarily of the same type.
Pregnancy & Breastfeeding
Penicillamine was teratogenic in rats when the dose was 6 times higher than the highest dose recommended for humans. Skeletal defects, cleft palates and fetal toxicity (resorptions) were reported. One report describes a woman with rheumatoid arthritis who took less than one gram of penicillamine a day during pregnancy. She gave birth by cesarean delivery to an infant with growth retardation, a flattened face with a broad nasal bridge, low set ears, a short neck with loose skin folds, and unusually lax body skin.
There are no controlled studies of penicillamine in pregnant women. Normal outcomes have been reported, but infants born to mothers who took penicillamine during pregnancy have also had characteristic congenital cutis laxa and related birth defects.
Women of childbearing potential should be given penicillamine only when the expected benefits outweigh the possible hazards. They should be told about this risk while on treatment, and they should be followed closely so that a pregnancy is recognised early.
⚠️ Talk to your doctor before taking any medicine during pregnancy or while breastfeeding.
Storage
Store Penicillamine below 30°C, and keep it away from light and moisture. Keep it out of the reach of children.
Drug Interactions
Common questions about Wilpen 250 mg
What is Wilpen 250 mg Capsule?
Wilpen 250 mg Capsule is a medicine that contains Penicillamine. It is made by Healthcare Pharmaceuticals Ltd.
What is Wilpen used for?
Wilpen is used for: Rheumatoid Arthritis.
What are the side effects of Wilpen?
Penicillamine causes unwanted reactions quite often, and some of them can be fatal. For this reason, anyone taking Penicillamine must stay under close medical supervision for the whole time they are on the medicine.
Can I take Wilpen during pregnancy or while breastfeeding?
Penicillamine was teratogenic in rats when the dose was 6 times higher than the highest dose recommended for humans. Skeletal defects, cleft palates and fetal toxicity (resorptions) were reported. Talk to your doctor before taking any medicine during pregnancy or while breastfeeding.
How should I store Wilpen?
Store Penicillamine below 30°C, and keep it away from light and moisture. Keep it out of the reach of children.
Can I take other medicines with Wilpen?
Some medicines can interact with Penicillamine, for example: Phenylbutazone 2 gm/, Ferrous Ascorbate + Folic Acid + Zinc Sulfate, Sodium Alginate + Sodium Bicarbonate + Calcium Carbonate, Zinc Sulfate Monohydrate, Sodium Feredetate Trihydrate, Carbonyl Iron + Folic Acid + Zinc Sulfate + Vitamin B Complex + Vitamin C. Tell your doctor or pharmacist about every medicine you take.
Is there a cheaper medicine with the same ingredient?
Wilpen is already among the lowest-priced brands of Penicillamine at this strength.
Do I need a prescription for Wilpen?
Wilpen is a prescription (Rx) medicine. Take it as your doctor advises.