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Penicillamine

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.

Interactions with Dietary 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.

Interactions with Foods and Other Compounds

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

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

For the convenience of the reader, the information in the summary is categorized as follows: “Depletion or interference” indicates the drug may deplete or interfere with the absorption or function of the supplement or herb. “Adverse interaction” indicates that the supplement or herb used together with the drug may result in undesirable effects. “Side effect reduction/prevention” indicates the supplement or herb may reduce the likelihood and/or severity of a potential side effect caused by the drug. “Supportive interaction” indicates the supplement or herb may support or aid the function of the drug. “Reduced drug absorption/bioavailability” indicates that the supplement or herb may decrease the absorption and/or activity of the drug in the body. An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

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.