Description of the medicine: Penicillamine (Penicillaminum)
D-2-amino-3-mercapto-3-methylbutyric acid, or D-3, 3-dimethylcysteine.
Synonyms: Artamine, Cuprenil, Artamin, Beracilline, Cuprenil, Cuprimine, Cupripen, Depamine, Distamine, b-Mercaptovalin, Mercaptyl, Metalcaptase, d-Penicillamin, Sulredox, Troloval, etc.
Penicillamine is a synthetic drug, which in structure can be considered as part of the penicillin molecule and is a dimethyl derivative of the amino acid cysteine. The drug is optically active. It is used as a D-form, as the L-form and racemate are more toxic.
The main property of penicillamine is its high complexing activity against metal ions. It binds mainly ions of copper, mercury, lead and iron, as well as calcium. The resulting complexes are removed by the kidneys.
Penicillamine is used for acute and chronic poisoning with these metals, as well as for Westphal-Wilson-Konovalov disease (hepatocerebral dystrophy). The drug enhances the removal with urine of excess copper from the tissues of patients suffering from this disease, and, according to reports, is more effective than typical compounds (see Unitiol).
In addition, penicillamine inhibits collagen synthesis in the body and normalizes the ratio between its soluble and insoluble fractions, contributing to this inhibition of the development of the sclerosing process in tissues. Under the influence of the drug, the level of pathological macroglobulins, including rheumatoid factor, decreases.
When administered, penicillamine is rapidly absorbed and for a long time is found in blood plasma; the half-life is 24 to 75 hours.
Penicillamine is prescribed for adults with various forms of rheumatoid arthritis in the absence of the effect of the use of conventional anti-inflammatory drugs. Penicillamine is considered as one of the main ("basic") agents in the treatment of this disease.
They are also used for systemic scleroderma and for some other diseases.
Take the drug inside after 2 - 2, 5 hours after eating.
With rheumatoid arthritis, they start with a dose of 150 - 300 mg per day. Every 2 to 4 weeks, the dose is increased by 150 mg to a total daily dose of 600 mg '. The first signs of clinical improvement (reduction of arthralgia, morning stiffness, exudative effects in the joints, etc.) usually appear after 2 to 3 months, less often at a later date. When the therapeutic effect is achieved, the drug is taken in a maintenance daily dose of 0.15-0.3 g.
In systemic scleroderma, penicillamine is prescribed in a daily dose of 0.15-0.3 g for 7-10 days. With good tolerance, the daily dose is increased by 0.15 g every week and adjusted to 1-2 g. At this dose, the drug is used for 6 months, then the dose is reduced by 0.15 g every week to 0.3 g per day. The maintenance dose is 0.3 g per day.
The duration of treatment is 1 year or more.
In Westphal-Wilson-Konovalov disease, large doses are used (2 g in the first days), under the control of the general condition and copper content in the urine. Children over 6 years of age are prescribed 0.25 g once a day.