Consumer medicine information

D-Penamine

Penicillamine

BRAND INFORMATION

Brand name

D-Penamine

Active ingredient

Penicillamine

Schedule

S4

 

Consumer medicine information (CMI) leaflet

Please read this leaflet carefully before you start using D-Penamine.

SUMMARY CMI

D-PENAMINE®

Consumer Medicine Information (CMI) summary

The full CMI on the next page has more details. If you are worried about using this medicine, speak to your doctor or pharmacist.

1. Why am I using D-PENAMINE?

D-PENAMINE contains the active ingredient D-penicillamine. D-PENAMINE is used to treat severe, active rheumatoid arthritis, lead poisoning, Wilson's disease and cystinuria.
For more information, see Section 1. Why am I using D-PENAMINE? in the full CMI.

2. What should I know before I use D-PENAMINE?

Do not use if you have ever had an allergic reaction to D-penicillamine or any of the ingredients listed at the end of the CMI.

Talk to your doctor if you have any other medical conditions, take any other medicines, or are pregnant or plan to become pregnant or are breastfeeding.
For more information, see Section 2. What should I know before I use D-PENAMINE? in the full CMI.

3. What if I am taking other medicines?

Some medicines may interfere with D-PENAMINE and affect how it works.
A list of these medicines is in Section 3. What if I am taking other medicines? in the full CMI.

4. How do I use D-PENAMINE?

  • Your doctor will tell you how many tablets you need to take each day and when to take them.
  • This depends on your condition and whether or not you are taking any other medicines.

More instructions can be found in Section 4. How do I use D-PENAMINE? in the full CMI.

5. What should I know while using D-PENAMINE?

Things you should do
  • Remind any doctor, dentist or pharmacist you visit that you are using D-PENAMINE.
  • If you plan to undergo any surgical procedures, especially vascular surgery tell your doctor that you are taking D-PENAMINE.
  • If you are about to have any blood tests, tell your doctor that you are taking this medicine.
Things you should not do
  • Do not stop taking D-PENAMINE, or change the dose, even if you are feeling better without checking with your doctor.
  • Do not use D-PENAMINE to treat any other conditions unless your doctor tells you to.
  • Do not give D-PENAMINE to anyone else, even if they have the same condition as you.
Looking after your medicine
  • Keep the tablets in a cool, dry place (below 25°C) in its original packaging.
  • Keep the bottle tightly closed.
  • Do not store D-PENAMINE in the bathroom, near a sink, on a window sill or in the car.
  • Keep your tablets where children cannot reach it.

For more information, see Section 5. What should I know while using D-PENAMINE? in the full CMI.

6. Are there any side effects?

Tell your doctor if you notice any of the following and they worry you: nausea, vomiting, diarrhoea, loss of appetite, impairment of taste, red or itchy rash accompanied by fever, joint pain, loss of hair, ringing in the ears, red, splitting lips, inflammation of the tongue, gums or mouth, swelling and redness along a vein which is extremely tender when touched, visual disturbances, muscle weakness, drooping eyelids, double vision, blisters on the skin, blisters containing dark blood, breast enlargement, inflammation of the blood vessels, symptoms of iron deficiency such as pale complexion and lowered vitality.

Tell your doctor immediately if you experience fever, sore throat, chills, bleeding or bruising more easily than normal.

For more information, including what to do if you have any side effects, see Section 6. Are there any side effects? in the full CMI.



FULL CMI

D-PENAMINE®

Active ingredient(s): D-penicillamine


Consumer Medicine Information (CMI)

This leaflet provides important information about using D-PENAMINE. You should also speak to your doctor or pharmacist if you would like further information or if you have any concerns or questions about using D-PENAMINE.

Where to find information in this leaflet:

1. Why am I using D-PENAMINE?
2. What should I know before I use D-PENAMINE?
3. What if I am taking other medicines?
4. How do I use D-PENAMINE?
5. What should I know while using D-PENAMINE?
6. Are there any side effects?
7. Product details

1. Why am I using D-PENAMINE?

D-PENAMINE contains the active ingredient D-penicillamine. D-PENAMINE is a chelating agent. This means that it binds to certain metals in the body including lead, copper, gold and mercury to help remove them from the body if necessary. D-PENAMINE is also used to relieve the pain and stiffness of rheumatoid arthritis if other medicines and rest have not helped.

D-PENAMINE is used to treat the following conditions:

  • severe, active rheumatoid arthritis (painful joint disease)
  • lead poisoning
  • Wilson's disease (a condition which results in too much copper in the body)
  • cystinuria (a condition which can result in kidney stones).

Ask your doctor if you have any questions about why D-PENAMINE has been prescribed for you.

Your doctor may have prescribed D-PENAMINE for another reason.

D-PENAMINE is available only with a doctor's prescription.

2. What should I know before I use D-PENAMINE?

Warnings

Do not use D-PENAMINE if:

  • you are allergic to D-PENAMINE or any of the ingredients listed at the end of this leaflet. Some of the symptoms of an allergic reaction may include:
    - shortness of breath
    - wheezing or difficulty breathing
    - swelling of the face, lips, tongue or other parts of the body
    - rash, itching or hives on the skin
    Always check the ingredients to make sure you can use this medicine.
  • you are receiving gold therapy or taking anti-malarial medicines.
  • the expiry date (EXP) printed on the pack has passed
    If you take this medicine after the expiry date has passed, it may not work as well.
  • the packaging shows signs of tampering
  • the tablets do not look quite right

If you are not sure whether you should start taking this medicine, talk to your doctor.

Check with your doctor if you:

  • are allergic to any other medicines including penicillin, or any other substances such as foods, dyes or preservatives
  • have, or have had, any medical conditions, especially the following:
    - kidney disease
    - liver disease
    Your doctor may want to take special care if you have any of these conditions

If you have not told your doctor about any of the above, tell them before you start taking D-PENAMINE.

During treatment, you may be at risk of developing certain side effects. It is important you understand these risks and how to monitor for them. See additional information under Section 6. Are there any side effects?

Pregnancy and breastfeeding

Tell your doctor if you are pregnant, intend to become pregnant, are breast-feeding or intend to breast-feed.

D-PENAMINE is not recommended for use during pregnancy. If there is a need to consider D-PENAMINE during your pregnancy or breast-feeding, your doctor or pharmacist will discuss with you the benefits and risks of using it.

3. What if I am taking other medicines?

Tell your doctor or pharmacist if you are taking any other medicines, including any medicines, vitamins or supplements that you buy without a prescription from your pharmacy, supermarket or health food shop.

Some medicines may be affected by D-PENAMINE, or may affect how well it works. These include:

  • isoniazid, a medicine used to treat tuberculosis.

Your doctor can tell you what to do if you are taking any of these medicines.

If you are not sure whether you are taking any of these medicines, check with your doctor or pharmacist.

Take D-PENAMINE one hour apart from other medicines.

Your doctor and pharmacist have more information on medicines to be careful with or avoid while taking D-PENAMINE.

4. How do I use D-PENAMINE?

Follow all directions given to you by your doctor and pharmacist carefully.

They may differ from the information contained in this leaflet.

If you do not understand the instructions on the pack, ask your doctor or pharmacist.

How much to take

  • Your doctor will tell you how many tablets you need to take each day and when to take them. This depends on your condition and whether or not you are taking any other medicines.
  • The usual starting dose for rheumatoid arthritis is no more than 250 mg daily for the first month. This dose is increased by the same amount at intervals of no less than one month until a daily dose of 1500 mg has been reached.
  • For the treatment of Wilson's disease, the usual dose of D-PENAMINE is 1500 mg to 2000 mg a day.
  • For the treatment of cystinuria, the usual dose of D-PENAMINE is 750 mg to 1000 mg a day in divided doses.
  • For the treatment of lead poisoning, the usual dose of D-PENAMINE is 250 mg to 1000 mg a day in divided doses.

When to take D-PENAMINE

  • Take D-PENAMINE on an empty stomach, for example, 1 hour before meals or 2 hours after meals, and at least one hour apart from any other medicine, food or milk.

How to take D-PENAMINE

  • Swallow the tablets whole with a glass of water.

How long to take D-PENAMINE for

  • Keep taking D-PENAMINE for as long as your doctor recommends.

If you forget to use D-PENAMINE

  • D-PENAMINE should be used regularly at the same time each day.
  • If it is almost time for your next dose, skip the dose you missed and take your next dose when you are meant to.
  • Otherwise, take the missed dose as soon as you remember, and then go back to taking your tablets as you would normally.
  • Do not take a double dose to make up for the dose you missed.
  • If you are not sure what to do or have any questions on this, ask your doctor or pharmacist.

If you use too much D-PENAMINE

If you think that you have used too much D-PENAMINE, you may need urgent medical attention.

You should immediately:

  • phone the Poisons Information Centre
    (Australia telephone 13 11 26) for advice, or
  • contact your doctor, or
  • go to the Emergency Department at your nearest hospital.

You should do this even if there are no signs of discomfort or poisoning.

5. What should I know while using D-PENAMINE?

Things you should do

  • Before starting any new medicine, tell your doctor or pharmacist that you are taking D-PENAMINE.
  • Tell all the doctors, dentists and pharmacists who are treating you that you are taking D-PENAMINE.
  • If you become pregnant while taking D-PENAMINE, tell your doctor.
  • If you plan to undergo any surgical procedures, especially vascular surgery tell your doctor that you are taking D-PENAMINE.
    Treatment with D-PENAMINE should, if possible, be discontinued for at least six weeks prior to surgery.
  • If you are about to have any blood tests, tell your doctor that you are taking this medicine.
    D-PENAMINE may affect the results of some tests.
  • Visit your doctor regularly so they can check on your progress.
    Your doctor may do some tests to check your blood, liver and kidneys from time to time, to make sure the medicine is working and to prevent unwanted side effects.

Things you should not do

  • Do not stop taking D-PENAMINE, or change the dose, even if you are feeling better without checking with your doctor.
  • Do not use D-PENAMINE to treat any other conditions unless your doctor tells you to.
  • Do not give D-PENAMINE to anyone else, even if they have the same condition as you.

Looking after your medicine

Keep D-PENAMINE where children cannot reach it.

A locked cupboard at least one-and-a-half metres above the ground is a good place to store medicines.

Keep your tablets in the bottle until it is time to take them.

If you take the tablets out of the bottle they will not keep well.

Keep the bottle tightly closed.

Keep your tablets in a cool dry place where the temperature stays below 25°C.

Do not store D-PENAMINE or any other medicine in the bathroom or near a sink.

Do not leave D-PENAMINE in the car or on window sills.

Heat and dampness can destroy this medicine.

Getting rid of any unwanted medicine

If your doctor tells you to stop taking D-PENAMINE, or your tablets have passed their expiry date, ask your pharmacist what to do with any that are left over.

6. Are there any side effects?

Tell your doctor or pharmacist as soon as possible if you do not feel well while you are taking D-PENAMINE.

All medicines can have side effects. If you do experience any side effects, most of them are minor and temporary. However, some side effects may need medical attention.

See the information below and, if you need to, ask your doctor or pharmacist if you have any further questions about side effects.

Do not be alarmed by this list of possible side effects.

You may not experience any of them.

Less serious side effects

Less serious side effectsWhat to do
  • nausea
  • vomiting
  • diarrhoea
  • loss of appetite
  • impairment of taste
  • red or itchy rash accompanied by fever, joint pain
  • loss of hair
  • ringing in the ears

The above list includes the more common side effects of D-PENAMINE.
  • red, splitting lips
  • inflammation of the tongue, gums or mouth
  • swelling and redness along a vein which is extremely tender when touched
  • visual disturbances
  • muscle weakness, drooping eyelids, double vision
  • blisters on the skin
  • blisters containing dark blood
  • breast enlargement
  • inflammation of the blood vessels
  • Goodpasture's syndrome, a syndrome characterised by coughing with production of mucous containing frothy, bright red blood; nausea; constipation; itching; less frequent urination
  • symptoms of iron deficiency such as pale complexion and lowered vitality.

All of the above side effects are very rare.

Speak to your doctor if you have any of these less serious side effects and they worry you.

Serious side effects

Serious side effectsWhat to do
  • Fever
  • sore throat
  • chills
  • bleeding
  • bruising more easily than normal
These are serious side effects which require medical attention.
Call your doctor straight away if you notice any of these serious side effects.

Tell your doctor or pharmacist if you notice anything else that may be making you feel unwell.

Other side effects not listed here may occur in some people.

Reporting side effects

After you have received medical advice for any side effects you experience, you can report side effects to the Therapeutic Goods Administration online at www.tga.gov.au/reporting-problems. By reporting side effects, you can help provide more information on the safety of this medicine.

Always make sure you speak to your doctor or pharmacist before you decide to stop taking any of your medicines.

7. Product details

This medicine is only available with a doctor's prescription.

What D-PENAMINE contains

Active ingredient
(main ingredient)
D-PENAMINE contains either 125 mg or 250 mg of D-penicillamine
Other ingredients
(inactive ingredients)
The tablets also contain:
  • povidone
  • microcrystalline cellulose
  • stearic acid
  • sodium starch glycollate.

The tablet coating contains:

  • hydroxypropyl methylcellulose
  • glycerol
  • titanium dioxide (E171)
Potential allergensD-PENAMINE tablets contain sulfites.

Do not take this medicine if you are allergic to any of these ingredients.

What D-PENAMINE looks like

D-PENAMINE tablets are available in 2 strengths:

  • D-PENAMINE 125 mg tablets are round, white to off-white regular biconvex coated tablets, upper surface embossed 'DS' lower surface embossed '125'. (AUST R 14625)
  • D-PENAMINE 250 mg tablets are round, white to off-white regular biconvex coated tablets, upper surface embossed 'DM' lower surface embossed '250'. (AUST R 14626)

Each bottle contains 100 tablets.

Who distributes D-PENAMINE

Alphapharm Pty Ltd trading as Viatris
Level 1, 30 The Bond
30-34 Hickson Road
Millers Point NSW 2000
www.viatris.com.au
Phone: 1800 274 276

This leaflet was prepared in July 2023.

D-PENAMINE® is a Viatris company trade mark

D-PENAMINE_cmi\Jul23/00

Published by MIMS September 2023

BRAND INFORMATION

Brand name

D-Penamine

Active ingredient

Penicillamine

Schedule

S4

 

1 Name of Medicine

Penicillamine.

2 Qualitative and Quantitative Composition

Each film coated tablet of D-Penamine contains either 125 mg or 250 mg of penicillamine as the active ingredient.

Excipients with known effect.

Contains sulfites.
For the full list of excipients, see Section 6.1 List of Excipients.

3 Pharmaceutical Form

D-Penamine 125 mg: round, white to off-white regular biconvex coated tablet, upper surface embossed 'DS' lower surface embossed '125'.
D-Penamine 250 mg: round, white to off-white regular biconvex coated tablet, upper surface embossed 'DM' lower surface embossed '250'.

4 Clinical Particulars

4.1 Therapeutic Indications

Severe, active rheumatoid arthritis.
As a chelating agent in the treatment of Wilson's disease and lead poisoning. D-Penamine will enhance the urinary excretion of gold and mercury and other heavy metals.
In the treatment of cystinuria in cases where high fluid regimens are not adequate, or in conjunction with them.

4.2 Dose and Method of Administration

For oral administration.
In all patients receiving D-penicillamine, it is important that D-Penamine be given on an empty stomach, at least one hour before meals or two hours after meals and at least one hour apart from any other drug, food or milk.

Rheumatoid disease.

Not more than 250 mg daily for one month, increasing by the same amount at intervals of not less than one month, until a daily dose of 1,500 mg has been reached. The dose should be kept to the lowest which is effective in order to minimise side effects. Many patients respond to a maintenance dose of 750 mg daily, and it may be worthwhile to keep patients on this dosage for several months before deciding on a further increment.
There is no predetermined dose of D-Penamine which will suit all patients, and the dose for each individual must be sought by careful monitoring over a period of months.
D-penicillamine should be given in divided doses. Therapeutic response to changes in maintenance dosage usually will not become evident for six to eight weeks.
Some do not respond despite continued use of full doses. There is little point in persevering with D-Penamine if there is no response after six months at a full maintenance dose.
Occasionally patients who have responded initially to a particular dose begin to relapse. Most of these will respond to an increase which should be gradual. Both seronegative and seropositive rheumatoid arthritis usually respond to D-Penamine.

As a chelating agent.

Wilson's disease.

Most adult patients require the drug in a daily dose of 1,500 to 2,000 mg. Improvement is often slow, though cupruresis is immediate and there may be clinical deterioration at first. Except in the most advanced case, substantial improvement can generally be expected. Patients who are vomiting or unable to swallow should be given parenteral E.D.T.A.

Lead poisoning.

Patients who are vomiting or who are unable to swallow should be given parenteral E.D.T.A., but all others are best treated by means of D-Penamine in an oral dose of 250 to 1,000 mg daily, in divided doses.

Other heavy metals poisoning.

D-Penamine will enhance the urinary excretion of gold, iron, antimony, zinc and mercury.

Cystinuria.

A single 500 mg dose on retiring, following free fluids during the day, may effect stone dissolution in a functioning kidney. 750 to 1,000 mg daily in divided doses is generally adequate and it should not be necessary to exceed 2,000 mg daily.

4.3 Contraindications

Hypersensitivity to D-penicillamine, except in a life threatening situation.
D-Penamine should not be used in patients who are receiving gold therapy or antimalarial drugs.

4.4 Special Warnings and Precautions for Use

Physicians planning to use D-Penamine should thoroughly familiarise themselves with potential toxicity and benefits. D-Penamine should never be used casually. Each patient should remain constantly under the close supervision of the physician. Patients should be warned to promptly report any symptoms suggesting toxicity.
The skin and mucous membranes should be observed for allergic reactions.
The use of D-penicillamine has been associated with fatalities due to aplastic anaemia, agranulocytosis, thrombocytopenia, Goodpasture's syndrome and myasthenia gravis.
Because of the potential for serious haematological and renal adverse reactions to occur at any time, haemoglobin determination, white and differential cell count, direct platelet count and urinalysis should be carried out at weekly intervals for the first four weeks, then at two weekly intervals for the next five months and monthly thereafter for the duration of therapy.
Patients should be instructed to report promptly fever, sore throat, chills, bruising or bleeding.
Some patients may experience drug fever, a marked febrile response to D-penicillamine, usually in the second or third week following initiation of therapy. Drug fever may sometimes be accompanied by a macular cutaneous reaction.
D-Penamine treatment should be withdrawn if the total WBC falls below 3,000 per cu. mm, neutrophils fall below 2,000 or platelets below 120,000, or if a steady decline over three successive tests is observed, even though the counts remain within the normal range.
If fever, or a reaction in the skin, blood or urine appears, D-Penamine should be discontinued until the reaction subsides. After this, it should be reinstituted in patients with Wilson's disease in a small dose that is gradually increased until full dosage is attained.
Liver function tests are advisable every six months during the first year and a half of therapy.
A nephrotic syndrome may develop during therapy, and proteinuria may be a warning sign of its development. Close observation of patients is essential. In some cases, proteinuria disappears with continued therapy; in other cases, the drug must be discontinued. When a patient develops proteinuria, the physician should ascertain that it is a symptom of the nephrotic syndrome and not transitory proteinuria unrelated to D-penicillamine. Withdraw treatment if albumin in the urine increases progressively to exceed 2 g per day.
If successive tests demonstrate haematuria, discontinue D-Penamine treatment immediately.
D-Penamine increases the requirement of pyridoxine (vitamin B6) and in rare cases causes central and peripheral nervous symptoms which could be due to pyridoxine deficiency. Some authorities recommend prophylactic administration of 25 mg pyridoxine daily.
When D-Penamine is used in cystinuria, an annual X-ray is advised. Cystine stones form rapidly, sometimes in six months.
Cross allergy to penicillin and D-penicillamine may occur and D-penicillamine should be used with caution in the penicillin hypersensitive patient.
A neurological examination prior to therapy is advisable to distinguish pre-existing neurological disturbances from any which may arise during treatment. Should neurological abnormalities occur (excluding loss of taste) D-penicillamine should be withdrawn and other appropriate therapy initiated.
Patients being treated with D-penicillamine should not be subjected to elective surgical procedures, especially vascular surgery, as D-penicillamine has the capacity to interfere with collagen cross links. Therapy with D-Penamine should, if possible, be discontinued for at least six weeks prior to surgery.
Some patients have experienced reversible optic neuritis, possibly related to pyridoxine deficiency, following the administration of a racemic mixture of penicillamine. However, symptoms of pyridoxine deficiency have not been reported in patients receiving D-penicillamine. Patients complaining of visual disturbances should undergo a full ophthalmological examination.
The frequency and severity of some of the adverse reactions are greatly reduced by gradual introduction of D-Penamine.

Use in the elderly.

No data available.

Paediatric use.

No data available.

Effects on laboratory tests.

See Section 4.8 Adverse Effects (Undesirable Effects).

4.5 Interactions with Other Medicines and Other Forms of Interactions

D-penicillamine potentiates isoniazid.

4.6 Fertility, Pregnancy and Lactation

Effects on fertility.

No data available.
(Category D)
Category D: drugs which have caused, are suspected to have caused or may be expected to cause, an increased incidence of human fetal malformations or irreversible damage. These drugs may also have adverse pharmacological effects. Accompanying texts should be consulted for further details.
D-penicillamine can cause cutis laxa in the human foetus. D-Penamine should not be given during pregnancy if possible because of its affinity for metals and cystine, and its effect on collagen. In severe, untreated Wilson's disease and when stones continue to form in patients with cystinuria, the benefits of therapy with the drug must be evaluated against the risk. A patient with cystinuria, who was treated with D-penicillamine 2 g a day during pregnancy, gave birth to a child with generalised connective tissue defect that may have been caused by D-penicillamine.
No information is available on concentration in breast milk.

4.7 Effects on Ability to Drive and Use Machines

The effects of this medicine on a person's ability to drive and use machines were not assessed as part of its registration.

4.8 Adverse Effects (Undesirable Effects)

D-penicillamine causes allergic reactions, the most common of which is a maculopapular or erythematous rash early in therapy, and occasionally accompanied by fever, arthralgia or lymphadenopathy. Urticaria has occurred.
Other adverse reactions that have been reported include nephrotic syndrome, hepatic dysfunction, falling hair, tinnitus, elevated sedimentation rate, eosinophilia, monocytosis, leukocytosis, thrombocytosis, thrombocytopenia, bone marrow hypoplasia, leukopenia, and granulocytopenia ranging in severity from asymptomatic and reversible to agranulocytosis with fatalities. Nausea, loss of appetite, vomiting and occasional diarrhoea may occur. Thrombophlebitis, pancreatitis, cheilosis, glossitis, gingivostomatitis, and elastosis perforans serpiginosa have been reported, but are rare. There may be reversible impairment of taste. A syndrome closely resembling disseminated erythematosus has been reported.
Severe and ultimately fatal glomerulonephritis and intra-alveolar haemorrhage (Goodpasture's syndrome) has occurred rarely.
Iron deficiency may develop, especially in menstruating women, and in children, supplemental iron therapy may be required.
It has been reported that D-penicillamine also can induce a pemphigus-like disorder, polymyosis and symptoms similar to those of myasthenia gravis.
There have been a few reports of increased serum alkaline phosphatase, and positive cephalin flocculation and thymol turbidity tests.
Reversible optic neuritis, possibly connected with pyridoxine deficiency, has been reported following administration of a racemic mixture of penicillamine.
D-penicillamine causes an increase in the amount of soluble collagen. In the rat, this results in inhibition of normal healing and also a decrease in tensile strength of intact skin. In man, this same abnormality probably is the cause of increased skin friability at sites especially subject to pressure or trauma, such as knees, shoulders, elbows, toes and buttocks. Extravasations of blood may occur. These may be purpuric, with external bleeding if the skin is broken, or they may appear as vesicles containing dark blood. Neither type is progressive. There is no apparent association with bleeding elsewhere in the body and no associated coagulation defect has been found. Therapy with D-Penamine may be continued in the presence of these lesions, although they may disappear if dosage is reduced.
The chelating action of the drug may cause increased excretion of other heavy metals such as zinc, mercury and gold.
Breast enlargement has been reported as a rare complication of D-penicillamine therapy in both women and men. Breast enlargement may resolve with discontinuation of D-penicillamine. Some patients required an anti-estrogen medication to decrease breast size. In a few patients breast enlargement was considerable and/or prolonged with poor resolution and others required surgery.
Cases of vasculitis have been reported following administration of penicillamine.

Reporting suspected adverse effects.

Reporting suspected adverse reactions after registration of the medicinal product is important. It allows continued monitoring of the benefit-risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions at www.tga.gov.au/reporting-problems.

4.9 Overdose

The treatment of D-penicillamine overdosage is nonspecific and essentially supportive. There is no known antidote.
For information on the management of overdose, contact the Poisons Information Centre on 13 11 26 (Australia).

5 Pharmacological Properties

5.1 Pharmacodynamic Properties

Mechanism of action.

D-Penamine (D-penicillamine) is the D isomer of 3-mercaptovaline. It is a characteristic degradation product of penicillins. Hydrolysis of penicillin yields only the D isomer which is used in clinical practice. Penicillamine is prepared in this way and is supplied as the free amino acid.
It is the stable thiol group that gives D-penicillamine its biological activity, making it an effective chelating agent for heavy metals. This enables it to form a soluble mixed disulphide with cystine and to depolymerise large protein molecules.
D-penicillamine will form a chelate with copper. If the sulphydryl groups of certain enzymes are blocked by copper, the free sulphydryl group of D-penicillamine may in some way be able to reactivate such enzymes, providing a second mechanism of action in Wilson's disease.
D-penicillamine also reduces excess cystine excretion in cystinuria. This is done, at least in part, by disulphide interchange between penicillamine and cystine, resulting in formation of penicillamine-cysteine disulphide, a substance that is much more soluble than cystine and is excreted readily.
It is not known how D-penicillamine acts in producing beneficial effects in rheumatoid arthritis. Known actions which might have a bearing on activity in rheumatoid disease include interference with the immune response, chelation of copper, dissociation of macroglobulins, effect on collagen, and antiviral activity.

Clinical trials.

No data available.

5.2 Pharmacokinetic Properties

Absorption.

D-penicillamine is readily absorbed from the alimentary tract following oral administration. Up to 80% of the absorbed dose is excreted in the urine mainly as penicillamine disulphide or as a mixed disulphide.

Distribution.

It appears that distribution of D-penicillamine is through the water space of the body. Plasma protein binding and tissue binding, especially by the skin, delay final clearance by several weeks. The initial half-life in blood is 20 minutes but this phase lasts for less than one hour. The half-life of the stored D-penicillamine is about 90 hours.

Metabolism.

No data available.

Excretion.

No data available.

5.3 Preclinical Safety Data

Genotoxicity.

No data available.

Carcinogenicity.

No data available.

6 Pharmaceutical Particulars

6.1 List of Excipients

Glycerol, hypromellose, microcrystalline cellulose, povidone, sodium starch glycollate, stearic acid, titanium dioxide.

6.2 Incompatibilities

Incompatibilities were either not assessed or not identified as part of the registration of this medicine.

6.3 Shelf Life

In Australia, information on the shelf life can be found on the public summary of the Australian Register of Therapeutic Goods (ARTG). The expiry date can be found on the packaging.

6.4 Special Precautions for Storage

Store below 25°C. Protect from moisture. Keep bottle tightly closed.

6.5 Nature and Contents of Container

Container type: HDPE bottle with a PP child resistant closure.
Pack size: 100 tablets.
Some strengths, pack sizes and/or pack types may not be marketed.

Australian register of therapeutic goods (ARTG).

AUST R 14625 - D-Penamine penicillamine 125 mg tablet bottle.
AUST R 14626 - D-Penamine penicillamine 250 mg tablet bottle.

6.6 Special Precautions for Disposal

In Australia, any unused medicine or waste material should be disposed of by taking it to your local pharmacy.

6.7 Physicochemical Properties

Chemical structure.


D-penicillamine is a white or practically white, crystalline powder, with a slight characteristic odour. It is slightly soluble in alcohol, insoluble in chloroform and ether but freely soluble in water.

CAS number.

22572-05-0.

7 Medicine Schedule (Poisons Standard)

S4 (Prescription Only Medicine).

Summary Table of Changes