Medications : D-Penamine (Generic D-Penicillamine)

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.Dosage and Administration:D-PENAMINE is intended for oral administration in adults. 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 DiseaseNot 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 1500 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 pre-determined 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 AgentWilson's diseaseMost adult patients require the medicine in a daily dose of 1500 mg to 2000 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 PoisoningPatients 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 1000 mg daily, in divided doses.Other heavy metals poisoningD-PENAMINE will enhance the urinary excretion of gold, iron, antimony, zinc and mercury.CystinuriaA single 500 mg dose on retiring, following free fluids during the day, may effect stone dissolution in a functioning kidney. 750 to 1000 mg daily in divided doses is generally adequate and it should not be necessary to exceed 2000 mg daily.ChildrenD-PENAMINE is not recommended for use in children.

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