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D-Penicillamine (Cuprimine®)


Indications and Usage


  • This drug chelates nuclides of copper, iron, mercury, lead, gold, and possibly other heavy metals.
  • It is FDA approved only for chelation of copper, as in Wilson's disease, and only a few other rare indications, as mentioned on the drug label. It is not approved for chelation of Polonium-210.
  • The chelated metals are excreted in the urine.
  • The adult dose is 250 mg p.o. qd between meals and at bedtime. May increase to 4 or 5 g qd in divided doses.

FDA Product Safety Info

  • Not FDA approved for the chelation of Polonium-210 or Cobalt-60.
  • Be very cautious if patient has a penicillin allergy.
  • Adverse events have been reported following use of penicillamine, including neutropenia, thrombocytopenia, and nephrotoxicity.
  • Physicians planning to use penicillamine should thoroughly familiarize themselves with its toxicity, special dosage considerations, and therapeutic benefits. Penicillamine should never be used casually. Each patient should remain constantly under the close supervision of the physician. Patients should be warned to report promptly any symptoms suggesting toxicity.

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References

  1. Although penicillamine is mentioned in NCRP Report No. 161, Vol. I (Management of Persons Contaminated with Radionuclides: Handbook National Council on Radiation Protection and Measurements, Bethesda, MD, 2008) as one possible treatment for Polonium-210 radionuclide decorportation, it is not FDA approved for this indication and it is not the NCRP preferred drug for Polonium-210 decorporation. There is some animal data but very little human data on this topic.
  2. Jefferson RD, Goans RE, Blain PG, Thomas SH. Diagnosis and treatment of polonium poisoning. Clin Toxicol (Phila). 2009 May;47(5):379-92. [PubMed Citation]
  3. Levitskaia TG, Creim JA, Curry TL, Luders T, Morris JE, Woodstock AD, Levinson B, Thrall KD. Evaluation of Cuprimine and Syprine for decorporation of (60)Co and (210)Po. Health Phys. 2010 Mar;98(3):471-9. [PubMed Citation]