Penicillamine (Distamine)

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Take the tablets 30-60 minutes before meals.

Do not take indigestion remedies or medicines containing iron or zinc, two hours before or after you take these tablets.

Penicillamine may cause blood disorders. Let your doctor know straightaway if you develop a sore throat, a high temperature (fever) or flu-like symptoms, mouth ulcers, a skin rash, or any unusual bruising or bleeding.

Type of medicineDisease-modifying antirheumatic drug (DMARD).
Used forAutoimmune diseases such as rheumatoid arthritis
Some metabolic disorders such as Wilson's disease and cystinuria
Also calledDistamine®
Available asTablets

Rheumatoid arthritis (RA) is thought to be an autoimmune disease. Your immune system normally makes antibodies to protect you from germs (bacteria and viruses). In people with autoimmune diseases, the immune system makes antibodies that attack the tissues of the body. It is not clear why this happens. Penicillamine belongs to a group of medicines known as disease-modifying antirheumatic drugs (DMARDs) and works by suppressing your immune system. This helps to stop it from attacking the tissues of your body and reduces the damaging effect of the disease on your joints.

Penicillamine is also used to treat some metabolic disorders such as Wilson's disease and cystinuria. In Wilson's disease, it works by binding to copper metal ions in the body so they can be more easily removed by the kidneys. In cystinuria, it lowers the amount of cystine in the urine. This prevents the formation of the crystals which form kidney or bladder stones.

Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking penicillamine it is important that your doctor or pharmacist knows:

  • If you are pregnant, trying for a baby or breast-feeding.
  • If you have any problems with the way your kidneys work.
  • If you have been told you have lupus erythematosus. This is also an autoimmune disease causing inflammation.
  • If you are taking or using any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.
  • If you have ever had an allergic reaction to a medicine.
  • Before you start this treatment, read the manufacturer's printed information leaflet from inside your pack. The leaflet will give you more information about penicillamine and a full list of side-effects which you may experience from taking it.
  • Take penicillamine exactly as your doctor tells you to. Your dose will depend upon the reason why you are taking it, so your doctor will tell you how many tablets to take each day, and when to take them. Your dose will also be on the label of the pack to remind you. If you are taking it for RA, your doctor may give you a small dose at first and then gradually increase it over a number of weeks.
  • You should take the tablets 'on an empty stomach', which means taking them 30-60 minutes before a meal, or at bedtime. Swallow the tablets whole with a glass of water.
  • Try to take your doses of penicillamine at the same times each day, as this will help you to remember to take them.
  • If you do forget to take a dose, take one as soon as you remember unless it is nearly time for your next dose. If you are due to take your next dose soon, skip the missed dose. Do not take two doses together to make up for a forgotten dose.
  • You should expect that penicillamine will build up its effect gradually. This means that you may not notice much improvement in your condition until after 6 to 12 weeks of taking the tablets.
  • It is important that you keep your regular appointments with your doctor or clinic so that your progress can be monitored. Also, your doctor will arrange for you to have regular blood tests, especially during the first two months of your treatment.
  • If you buy any medicines, check with a pharmacist that they are suitable for you to take. This is because some medicines interfere with penicillamine and may either stop it from working fully, or increase the risk that you will experience side-effects. This includes vitamin/mineral supplements, antacids, and anti-inflammatory painkillers such as ibuprofen.
  • Treatment with penicillamine is usually long-term unless you experience an adverse effect. Continue to take the tablets unless your doctor recommends otherwise.
  • If you are having an operation or dental treatment, tell the person carrying out the treatment that you are taking penicillamine.

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. These usually improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following side-effects continue or become troublesome.

Possible penicillamine side-effectsWhat can I do if I experience this?
Feeling or being sick, loss of appetiteStick to simple foods - avoid rich or spicy meals
DiarrhoeaDrink plenty of water
HeadacheAsk your doctor or pharmacist to recommend a suitable painkiller
Feeling dizzy, eyesight changesIf this happens, until you feel better, do not drive and do not use machinery or tools.
Loss of tasteThis is temporary

Your doctor will discuss with you the possibility of unwanted side-effects caused by blood disorders. You should let your doctor know straightaway if you develop any of the following:

  • Sore throat with a high temperature (fever) or flu-like symptoms.
  • Mouth ulcers.
  • Skin rash.
  • Unusual bruising or bleeding.
  • Blood in your urine.
  • Feel generally unwell.

If you are taking penicillamine for RA and your joints become more painful, swollen, red or hot let your doctor know straightaway.

If you experience any other symptoms which you think may be due to this medicine, speak with your doctor or pharmacist.

  • Keep all medicines out of the reach and sight of children.
  • Store in a cool, dry place, away from direct heat and light.

Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital at once. Take the container with you, even if it is empty.

This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.

Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.

If you have any questions about this medicine ask your pharmacist.

Further reading & references

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.

Original Author:
Helen Allen
Current Version:
Peer Reviewer:
Dr John Cox
Document ID:
3254 (v24)
Last Checked:
20/06/2016
Next Review:
20/06/2019
The Information Standard - certified member

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