Penicillamine (drug interactions)
Penicillamine is a medication primarily used to treat rheumatoid arthritis and Wilson's disease, a genetic disorder that disrupts copper metabolism, leading to serious health issues. When using penicillamine, it is crucial to be aware of various drug interactions that can affect its efficacy and safety. For instance, copper supplements should be avoided in patients with Wilson's disease, as penicillamine is designed to remove excess copper from the body. Additionally, long-term use of penicillamine may necessitate vitamin B6 supplementation, typically recommended at doses of 25 to 50 mg daily.
Interactions also extend to minerals and other medications; zinc and iron supplements should not be taken within two hours of penicillamine, as they can impair its absorption. Concurrent use of chloroquine, a medication for malaria, is discouraged due to the increased risk of muscle-related side effects. It is also advisable to avoid herbs that can thin the blood or affect immune responses, as well as certain antacids, which can interfere with the absorption of penicillamine. Overall, due to the complexity of its interactions, close attention to medication timing and dietary supplements is essential for individuals taking penicillamine.
Penicillamine (drug interactions)
- DEFINITION: Drug used to treat rheumatoid arthritis and Wilson’s disease, an inherited disorder affecting copper metabolism and causing cirrhosis and brain and eye problems.
- INTERACTIONS: Copper, iron, vitamin B6, zinc, herbs with blood-thinning effects, herbs that affect the immune system, various prescription medications
- TRADE NAMES: Cuprimine, Depen
Copper
Effect: Avoid in Cases of Wilson’s Disease
Penicillamine removes copper from the body when used to treat Wilson’s disease. Therefore, copper supplements should be avoided while using penicillamine for this condition.
Vitamin B6
Effect: Possible Need for Supplementation
Penicillamine might increase the need for vitamin B6. Taking 25 to 50 milligrams (mg) of supplemental vitamin B6 daily is often recommended.
Zinc
Effect: Supplementation Possibly Helpful, but Take at a Different Time of Day
Long-term use of penicillamine can cause zinc deficiency. However, zinc can impair penicillamine absorption, so people should not take zinc supplements during the two hours before or after taking penicillamine.
Iron
Effect: Take at a Different Time of Day
Penicillamine attaches to the mineral iron, impairing the absorption of both substances. People who need iron supplements should not take them during the two hours before or after taking penicillamine.
Chloroquine
Effect: Avoid
Combining the malaria medication chloroquine with Penicillamine increases the risk and severity of myopathy, rhabdomyolysis, and myoglobinuria. Additionally, the combination may increase the risk of hematological toxicity.
Other Interactions
Several potential interactions exist between penicillamine and other medications, herbs, and supplements. It is best to avoid herbs with blood-thinning effects and those that affect the immune system. Antacids can interfere with penicillamine absorption and should not be taken within one to two hours of each other. Gold salts, antimalarial drugs, phenylbutazone, drugs that affect bone marrow, and digoxin can increase the side effects of penicillamine.
Bibliography
Campbell, N. R., and B. B. Hasinoff. "Iron Supplements: A Common Cause of Drug Interactions." British Journal of Clinical Pharmacology, vol. 31, no. 3, 1991, pp. 251-255.
Meijas, Stephanie. "Penicillamine - StatPearls." NCBI, 27 Mar. 2023, www.ncbi.nlm.nih.gov/books/NBK513316. Accessed 22 Sept. 2024.
"Penicillamine." MedlinePlus, 15 Apr. 2018, medlineplus.gov/druginfo/meds/a618021.html. Accessed 22 Sept. 2024.
Pronsky, Z. M., and J. P. Crowe. Food Medication Interactions. 19th ed., Food-Medication Interactions, 2018.