Since penicillamine is taken in different ways for different medical problems, it is very important that you understand exactly why you are taking this medicine and how to take it. See below for information on specific medical problems. If you have any questions about this, check with your doctor.

For patients taking this medicine to prevent kidney stones:

• Take this medicine on an empty stomach (at least 1 hour before meals or 2 hours after meals) and at least 1 hour before or after any other food, milk, or medicine.
• You should drink 2 full glasses (8 ounces each) of water at bedtime and another 2 full glasses (8 ounces each) during the night.
• It is very important that you follow any special instructions from your doctor, such as following a low-methionine diet. If you have any questions about this, check with your doctor.

For patients taking this medicine for rheumatoid arthritis :

• Take this medicine on an empty stomach (at least 1 hour before meals or 2 hours after meals) and at least 1 hour before or after any other food, milk, or medicine.
• After you begin taking this medicine, 2 to 3 months may pass before you feel its effects. It is very important that you keep taking the medicine, even if you do not feel better, in order to give it time to work.

For patients taking this medicine for Wilson's disease :

• Take this medicine on an empty stomach (at least to 1 hour before meals or 2 hours after meals).
• It is very important that you follow any special instructions from your doctor, such as following a low-copper diet. If you have any questions about this, check with your doctor.
• After you begin taking this medicine, 1 to 3 months may pass before you notice any improvement in your condition.

For patients taking this medicine for lead poisoning :

• Take this medicine on an empty stomach (2 hours before meals or at least 3 hours after meals).

For all patients:

• Take this medicine regularly as directed. Do not stop taking it without first checking with your doctor, since stopping the medicine and then restarting it may increase the possibility of side effects.

Dosing

The dose of penicillamine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of penicillamine. If your dose is different, do not change it unless your doctor tells you to do so.

• For oral dosage forms (capsules or tablets):
  • For Wilson's disease (too much copper in the body):
    • Adults and teenagers At first, 250 milligrams (mg) four times a day. After a while your doctor may need to increase the dose, depending on the amount of copper in your urine. Most people do not need more than 2000 mg a day (two 250-mg capsules or tablets four times a day).
    • Children (older than 6 months of age) At first, 250 mg a day. After a while your doctor may need to increase the dose, depending on the amount of copper in your urine. Older children may need the same dose as adults.
  • For rheumatoid arthritis:
    • Adults At first, 125 or 250 mg once a day. Your doctor may increase the dose after a few months, depending on how well the medicine is working and whether it causes any side effects. The largest dose is not more than 1500 mg a day (two 250-mg capsules or tablets three times a day).
    • Children Use and dose must be determined by your doctor.
  • For preventing kidney stones:
    • Adults At first, 500 mg (two 250-mg capsules or tablets) four times a day. After a while your doctor may need to change the dose, depending on the results of your urine tests. Some people may need as much as 4000 mg a day (four 250-mg capsules or tablets four times a day).
    • Children The dose is based on body weight and must be determined by your doctor. At first, 7.5 mg per kilogram (kg) (about 3.5 mg per pound) of body weight four times a day. After a while your doctor may need to change the dose, depending on the results of your urine tests.

Missed dose

If you miss a dose of this medicine and your dosing schedule is:

• One dose a day Take the missed dose as soon as possible. But if you do not remember the missed dose until the next day, skip the missed dose and go back to your regular dosing schedule. Do not double the next day's dose.
• Two doses a day Take the missed dose as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
• More than two doses a day If you remember within an hour or so of the missed dose, take it right away. But if you do not remember until later, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

If you have any questions about this, check with your doctor.

Storage

To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store this medicine in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For penicillamine, the following should be considered:

Allergies Tell your doctor if you have ever had any unusual or allergic reaction to penicillin or to penicillamine. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy Penicillamine may cause birth defects if taken during pregnancy.

Breast-feeding It is not known whether penicillamine passes into breast milk. Use of this medicine is not recommended in women who are breast-feeding.

Children Although there is no specific information about the use of penicillamine in children, it is not expected to cause different side effects or problems in children than it does in adults.

Older adults Sore throat and fever, with or without chills; sores, ulcers, or white spots on the lips or in the mouth; shortness of breath, troubled breathing, tightness in the chest, and/or wheezing; swollen and/or painful glands; black, tarry stools; blood in urine or stools; pinpoint red spots on skin; cough or hoarseness; lower back or side pain; painful or difficult urination; unusual bleeding or bruising; and unusual tiredness or weakness may be especially likely to occur in elderly patients, who are usually more sensitive than younger adults to some of the effects of penicillamine.

Other medicines Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking penicillamine, it is important that your health care professional know if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine, especially:

• Gold compounds (e.g., Ridaura) or
• Phenylbutazone (e.g., Cotylbutazone) The chance of serious side effects may be increased

• Blood disease caused by penicillamine treatment, history of or
• Kidney disease or history of (only for patients with rheumatoid arthritis) The chance of side effects may be increased