Penicillamine

Penicillamine
Clinical data
Trade names Cuprimine, Cuprenyl, Depen, others
AHFS/Drugs.com Monograph
Pregnancy
category
  • AU: D
  • US: D (Evidence of risk)
Routes of
administration		 by mouth (capsules)
ATC code
Legal status
Legal status
  • US: ℞-only
  • In general: ℞ (Prescription only)
Pharmacokinetic data
Bioavailability Variable
Metabolism liver
Biological half-life 1 hour
Excretion kidney
Identifiers
CAS Number
PubChem CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
ECHA InfoCard 100.000.136
Chemical and physical data
Formula C5H11NO2S
Molar mass 149.212 g/mol
3D model (JSmol)
  (verify)

Penicillamine, sold under the trade names of Cuprimine among others, is a medication primarily used for the treatment of Wilson's disease.[1] It is also used for people with kidney stones who have high urine cystine levels, rheumatoid arthritis, copper poisoning, and lead poisoning.[1][2] It is taken by mouth.[2]

Common side effects include rash, loss of appetite, nausea, diarrhea, and low blood white blood cell levels. Other serious side effects include liver problems, obliterative bronchiolitis, and myasthenia gravis.[1] It is not recommended in people with lupus erythematosus.[2] Use during pregnancy may result in harm to the baby.[2] Penicillamine works by binding heavy metals such that they can be removed from the body in the urine.[1]

Penicillamine was approved for medical use in the United States in 1970.[1] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[3] The wholesale cost in the developing world is about 0.55 to 1.20 USD a dose.[4] In the United States treatment costs more than 200 USD per month.[5]

Medical uses

It is used as a chelating agent:

Penicillamine can be used as a disease-modifying antirheumatic drug (DMARD) to treat severe active rheumatoid arthritis in patients who have failed to respond to an adequate trial of conventional therapy,[11] although it is rarely used today due to availability of TNF inhibitors and other agents, such as tocilizumab and tofacitinib. Penicillamine works by reducing numbers of T-lymphocytes, inhibiting macrophage function, decreasing IL-1, decreasing rheumatoid factor, and preventing collagen from cross-linking.

Adverse effects

Bone marrow suppression, dysgeusia, anorexia, vomiting and diarrhea are the most common side effects, occurring in ~20–30% of the patients treated with penicillamine.[12][13]

Other possible adverse effects include:

Chemistry

Penicillamine is a trifunctional organic compound, consisting of a thiol, an amine, and a carboxylic acid. It is very similar chemically to the α-amino acid cysteine, but with geminal methyl groups α to the thiol (SH) group. Like most amino acids, it is a colorless solid that exists in the zwitterionic form. Of its two enantiomers, L-penicillamine is toxic because it inhibits the action of pyridoxine (also known as vitamin B6).[20] L-penicillamine is a metabolite of penicillin. It has no antibiotic properties.[21]

History

John Walshe first described the use of penicillamine in Wilson's disease in 1956.[22] He had discovered the compound in the urine of patients (including himself) who had taken penicillin, and experimentally confirmed that it increased urinary copper excretion by chelation. He had initial difficulty convincing several world experts of the time (Denny Brown and Cumings) of its efficacy, as they held that Wilson's disease was not primarily a problem of copper homeostasis but of amino acid metabolism, and that dimercaprol should be used as a chelator. Later studies confirmed both the copper-centered theory and the efficacy of D-penicillamine. Walshe also pioneered other chelators in Wilson's such as triethylene tetramine, 2 HCl, and tetrathiomolybdate.[23]

Penicillamine has been used in rheumatoid arthritis since the first successful case in 1964.[24] Cuprimine remains in production (2016) by Aton Pharma.[25]

References

  1. 1 2 3 4 5 "Penicillamine". The American Society of Health-System Pharmacists. Retrieved 8 December 2016.
  2. 1 2 3 4 WHO Model Formulary 2008 (PDF). World Health Organization. 2009. pp. 64, 592. ISBN 9789241547659. Retrieved 8 December 2016.
  3. ↑ "WHO Model List of Essential Medicines (19th List)" (PDF). World Health Organization. April 2015. Retrieved 8 December 2016.
  4. ↑ "Penicillamine". International Drug Price Indicator Guide. Retrieved 8 December 2016.
  5. ↑ Hamilton, Richart (2015). Tarascon Pocket Pharmacopoeia 2015 Deluxe Lab-Coat Edition. Jones & Bartlett Learning. p. 471. ISBN 9781284057560.
  6. ↑ Peisach, J.; Blumberg, W. E. (1969). "A mechanism for the action of penicillamine in the treatment of Wilson's disease". Molecular Pharmacology. 5 (2): 200–209. PMID 4306792.
  7. 1 2 Rosenberg, L. E.; Hayslett, J. P. (1967). "Nephrotoxic Effects of Penicillamine in Cystinuria". JAMA: The Journal of the American Medical Association. 201 (9): 698. doi:10.1001/jama.1967.03130090062021.
  8. ↑ Steen, V. D.; Medsger Jr, T. A.; Rodnan, G. P. (1982). "D-Penicillamine therapy in progressive systemic sclerosis (scleroderma): A retrospective analysis". Annals of Internal Medicine. 97 (5): 652–659. PMID 7137731. doi:10.7326/0003-4819-97-5-652.
  9. ↑ Peterson, R. G.; Rumack, B. H. (1977). "D-Penicillamine therapy of acute arsenic poisoning". The Journal of Pediatrics. 91 (4): 661–666. PMID 908992. doi:10.1016/S0022-3476(77)80528-3.
  10. ↑ Hall, A. H. (2002). "Chronic arsenic poisoning". Toxicology Letters. 128 (1–3): 69–72. PMID 11869818. doi:10.1016/S0378-4274(01)00534-3.
  11. ↑ "Cuprimine (penicillamine) Capsules for Oral Use. U.S. Full Prescribing Information" (PDF). Retrieved 29 April 2016.
  12. 1 2 3 Camp, A. V. (1977). "Penicillamine in the treatment of rheumatoid arthritis". Proceedings of the Royal Society of Medicine. 70 (2): 67–69. PMC 1542978 Freely accessible. PMID 859814.
  13. ↑ Grasedyck, K. (1988). "D-Penicillamine—side effects, pathogenesis and decreasing the risks". Zeitschrift für Rheumatologie. 47 Suppl 1: 17–19. PMID 3063003.
  14. 1 2 Fishel, B.; Tishler, M.; Caspi, D.; Yaron, M. (1989). "Fatal aplastic anaemia and liver toxicity caused by D-penicillamine treatment of rheumatoid arthritis". Annals of the rheumatic diseases. 48 (7): 609–610. PMC 1003826 Freely accessible. PMID 2774703. doi:10.1136/ard.48.7.609.
  15. ↑ Mitchell, Richard Sheppard; Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson. "Table 14-2". Robbins Basic Pathology (8th ed.). Philadelphia: Saunders. ISBN 1-4160-2973-7.
  16. ↑ Chalmers, A.; Thompson, D.; Stein, H. E.; Reid, G.; Patterson, A. C. (1982). "Systemic lupus erythematosus during penicillamine therapy for rheumatoid arthritis". Annals of Internal Medicine. 97 (5): 659–663. PMID 6958210. doi:10.7326/0003-4819-97-5-659.
  17. ↑ Bolognia, Jean; et al. (2007). Dermatology. Philadelphia: Elsevier. ISBN 1-4160-2999-0.2nd edition.
  18. ↑ Underwood, J. C. E. (2009). General and Systemic Pathology. Elsevier Limited. ISBN 978-0-443-06889-8.
  19. ↑ Taylor; Cumming; Corenblum (January 31, 1981). "Successful treatment of D-penicillamine-induced breast gigantism with danazol". Br Med J. 282: 362–3. PMC 1504185 Freely accessible. PMID 6780026. doi:10.1136/bmj.282.6261.362-a.
  20. ↑ Aronson, J. K. (2010). Meyler's Side Effects of Analgesics and Anti-inflammatory Drugs. Amsterdam: Elsevier Science. p. 613. ISBN 9780080932941.
  21. ↑ Parker, C. W.; Shapiro, J.; Kern, M.; Eisen, H. N. (1962). "Hypersensitivity to penicillenic acid derivatives in human beings with penicillin allergy". The Journal of Experimental Medicine. 115 (4): 821–838. PMC 2137514 Freely accessible. PMID 14483916. doi:10.1084/jem.115.4.821.
  22. ↑ Walshe, J. M. (Jan 1956). "Wilson's disease; new oral therapy". Lancet. 270 (6906): 25–6. PMID 13279157. doi:10.1016/S0140-6736(56)91859-1.
  23. ↑ Walshe, J. M. (Aug 2003). "The story of penicillamine: a difficult birth". Mov. Disord. 18 (8): 853–9. PMID 12889074. doi:10.1002/mds.10458.
  24. ↑ Jaffe, I. A. (1964). "Rheumatoid Arthritis with Arteritis; Report of a Case Treated with Penicillamine". Annals of Internal Medicine. 61: 556–563. PMID 14218939. doi:10.7326/0003-4819-61-3-556.
  25. ↑ http://www.cuprimine.com/
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