Cuprenil® [Penicillamine]

Brand Teva

Dosage form

pills

Brand & Manufacturer

Package Size

250 mg 100 pcs

$75.81

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Clinical Pharmacology

Cuprenil has a complexing, immunosuppressive, inhibitory collagen synthesis effect.

Indications

Konovalov-Wilson disease;
poisoning with copper, inorganic compounds of mercury, lead, gold, zinc;
hemosiderosis;
cystine nephrolithiasis;
scleroderma;
rheumatoid arthritis;
alcoholic cirrhosis with hepatomegaly;
fibroplastic form of glomerulonephritis.

Composition

1 tab. contains penicillamine 250 mg, excipients: potato starch; PVP; talc; magnesium stearate; hydroxymethylpropylcellulose; polyoxyethylene glycol; titanium dioxide; dye (E122)

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Dosage and Administration

Kuprenil take orally, 1-2 hours before meals or 2 hours after a meal or other drugs. To wash down exclusively with water.

When Wilson's disease - Konovalov: for adults - at the beginning of treatment 250 mg / day, gradually increasing the dose to 1500 mg, rarely up to 2000 mg / day. The daily dose is taken fractionally during the day. The dose of Cuprenil is considered effective if the daily excretion of copper in the urine (after 1 week of treatment) exceeds 2 mg. In the future, the adequacy of the dose is determined on the basis of the level of free copper in the serum (not less than 10 μg / ml). Children - 20 mg / kg / day, the maximum daily dose - 500 mg.

In acute metal poisoning: adults - 750-1500 mg / day, children - 30-40 mg / kg / day.

With cystinuria: adults - 750-2000 mg / day with simultaneous prescription of vitamin B6 and compensation for copper deficiency, for children - 90 mg / kg / day.

In rheumatoid arthritis and scleroderma: Initial dose of Cuprenyl is 125 mg / day for the first week with regular general blood and urine tests. From the second week, the dose is increased to 250 mg / day, from the third to 375 mg / day. Treatment with the last dose (375 mg / day) is carried out every day for 3 months. The maximum dose of Cuprenil is 500 mg / day; if it is ineffective, treatment is canceled. With the improvement of the condition, the treatment is continued for 1-2 years, gradually reducing the dose to 250 mg, taken 1 time in 2 days.

With alcoholic cirrhosis of the liver: on an empty stomach, no less than 1 hour before or 2 hours after a meal (recommended before dinner), and no earlier than 1 hour after taking any other drugs, 250-125 mg once a day. Therapy is carried out under careful control of the activity of ALT and AST in the blood plasma.

Adverse reactions

On the part of the digestive system: anorexia, nausea, vomiting, diarrhea, aphthous stomatitis, glossitis, intrahepatic cholestasis, pancreatitis.
On the part of the hematopoietic system: eosinophilia, thrombocytopenia, leukopenia, anemia (aplastic or hemolytic), agranulocytosis.
On the part of the respiratory system: interstitial pneumonitis, diffuse fibrosing alveolitis, Goodpasture syndrome.
From the side of the central nervous system and peripheral nervous system: complete loss or distortion of taste sensations; rarely reversible polyneuritis (associated with vitamin B6 deficiency).
Dermatological reactions: skin rash, epidermal necrolysis, alopecia.
Allergic reactions: allergic alveolitis, fever, polymyositis, dermatomyositis, lupus-like reactions (arthralgia, myalgia, erythematous rash, appearance of antinuclear antibodies and antibodies to DNA).
Other: nephritis, an increase in the mammary glands with the development of galactorrhea (in women), myasthenia.

Contraindications

hypersensitivity;
agranulocytosis;
systemic lupus erythematosus;
myasthenia gravis;
renal failure.

Drug interactions

Iron preparations reduce the absorption of penicillamine and weaken its therapeutic effect.

Penicillamine enhances the neurotoxic effect of isoniazid.

With simultaneous use with penicillamine, a decrease in the level of digoxin in the blood plasma is possible.

Pregnancy and Lactation

During pregnancy in patients with Konovalov-Wilson's disease or cystinuria, penicillamine therapy is continued at a dose of no more than 1 g / day, in patients with rheumatoid arthritis, penicillamine is canceled.

If necessary, the use of penicillamine during lactation should stop breastfeeding.

Special instructions

Given the possibility of serious, sometimes life-threatening adverse reactions (especially frequent in patients with rheumatoid arthritis), penicillamine is used only under constant medical supervision. During treatment, a urinalysis and a clinical blood test should be monitored 1 time in 2 weeks during the first 6 months of treatment, and then monthly; 1 time in 6 months control liver function.

In case of Konovalov-Wilson's disease or cystinuria, along with penicillamine, vitamin B is prescribed to be taken continuously.₆ (due to dietary restrictions used to treat these diseases); With prolonged treatment, these patients should be regularly X-ray or ultrasound of the kidneys and urinary tract. If signs of vitamin B deficiency develop₆ In patients with rheumatoid arthritis, as well as if the symptoms of this deficiency do not go away on their own, vitamin B is also prescribed.₆ at a dose of 25 mg / day.

A slow, gradual increase in the dose of penicillamine reduces the incidence of some adverse reactions. If a fever, lung, liver, severe hematological or neurological disorders, myasthenia, hematuria, lupus-like reactions, or other serious adverse reactions develop during the treatment, penicillamine is canceled and, if necessary, GCS is administered. In the case of the development of isolated proteinuria, if it does not increase and does not exceed 1 g / day, treatment with penicillamine is continued, in other cases it is canceled.