Penicillamine

Alternative Medicine The following information is specific for alternative and complementary medicine. For additional evidence-based information on diseases, conditions, symptoms, diagnosis, treatment and wellness issues, continue searching the Healthwise Knowledgebase.

Also indexed as:

Cuprimine, Depen

Penicillamine is a chelating agent (binds metals and carries them out of the body). Penicillamine is used to treat people with Wilson's disease, cystinuria, and severe rheumatoid arthritis.

Herbs

Summary of Interactions for Penicillamine

Depletion or interference	Sodium* Vitamin B6
Adverse interaction	None known
Side effect reduction/prevention	None known
Supportive interaction	Bromelain
Reduced drug absorption/bioavailability	Guar gum* Iron Zinc
Other (see text)	Copper

An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

Interactions with Supplements

Copper

One of the main uses of penicillamine is to reduce toxic copper deposits in people with Wilson's disease. People taking a copper supplement can make Wilson's disease worse and may negate the benefits of drugs used to remove copper from the body.

Iron

Penicillamine binds iron. When taken with iron, penicillamine absorption and activity are reduced.¹ Four cases of penicillamine-induced kidney damage were reported when concomitant iron therapy was stopped, which presumably led to the increased penicillamine absorption and toxicity.²

Vitamin B6

Penicillamine may increase vitamin B6 excretion, reduce activity, and increase the risk for vitamin B6 deficiency.³ It makes sense for people taking penicillamine to supplement with small (5-20 mg per day) amounts of vitamin B6. Some researchers have suggested that as much as 50 mg per day of vitamin B6 may be necessary.⁴

Zinc

People taking penicillamine should discuss with their doctor whether it would be appropriate to take a zinc supplement (at a separate time of day from the penicillamine).⁵ However, people taking penicillamine should not supplement with zinc, unless they are being supervised by a doctor.

Bromelain

One report found bromelain improved the action of antibiotic drugs, including penicillin and erythromycin, in treating a variety of infections. In that trial, 22 out of 23 people who had previously not responded to the antibiotics did so after adding bromelain four times per day.⁶ Doctors will sometimes prescribe enough bromelain to equal 2,400 gelatin dissolving units (listed as GDU on labels) per day. This amount would equal approximately 3,600 MCU (milk clotting units), another common measure of bromelain activity.

Guar gum

In a double-blind study with ten healthy people, guar gum reduced penicillin absorption.⁷ Until more is known, to avoid this interaction, people taking penicillin should take it two hours before or after any guar gum-containing supplements. It remains unclear whether the smaller amounts of guar gum found in many processed foods would have a significant effect.

Sodium

Penicillamine therapy has been associated with sodium depletion.⁸ The frequency of this association remains unclear.

Other Interactions

Food

Food decreases penicillamine absorption.⁹ Penicillamine should be taken one hour before or two hours after any food to avoid this interaction.

References

1. Threlkeld DS, ed. Miscellaneous Products, Penicillamine. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Aug 1996, 714-6b.
2. Harkness JAL, Blake DR. Penicillamine nephropathy and iron. Lancet 1982;ii:1368-9.
3. Holt GA. Food & Drug Interactions. Chicago: Precept Press, 1998, 203.
4. Rothschild B. Pyridoxine deficiency. Arch Intern Med 1982;142:840.
5. Holt GA. Food & Drug Interactions. Chicago: Precept Press, 1998, 201.
6. Neubauer RA. A plant protease for potentiation of and possible replacement of antibiotics. Exp Med Surg 1961;19:143-60.
7. Huupponen R, Seppala P, Iisalo E. Effect of guar gum, a fibre preparation, on digoxin and penicillin absorption in man. Eur J Clin Pharmacol 1984;26:279-81.
8. Holt GA. Food & Drug Interactions. Chicago: Precept Press, 1998, 202
9. Threlkeld DS, ed. Miscellaneous Products, Penicillamine. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Aug 1996, 714-6b.

---

Last Review: 01-21-2009

Copyright © 2009 Aisle7  All rights reserved.  www.Aisle7.net

Please read the disclaimer about the limitations of the information provided here. Do NOT rely solely on the information in this article.

Learn more about Aisle7.

Learn more about the authors of Using Medicines with Vitamins and Herbs

The information presented in Aisle7 is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires February 2010.

	Go to top of page
This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.