• Type: Antidote, anti-rheumatic
  • Dosage Forms:
  • Routes of Administration: Oral
  • Common Trade Names: Cuprimine, Depen

Adult Dosing

  • Mercury toxicity: 250mg PO QID x 1-2wks
  • Arsenic toxicity: 100 mg/kg/day PO divided q6hr x 5 days
  • Lead toxicity: 1-1.5 g daily PO or divided BID-TID x 1-6 months
  • Cystinuria: 1-4g/day PO, goal urinary cysteine excretion 100 to 200 mg/day in patients with no stone history, <100mg/day if history of stones/pain
  • Rheumatoid arthritis: 125-1500mg/day PO
  • Wilson's disease: 750-1500mg/day, based on urinary copper excretion

Pediatric Dosing

  • Lead toxicity (3rd line): 20-40 mg/kg/day PO divided q8hr
  • Wilson's disease: 20 mg/kg/day PO divided q12hr
  • Cystinuria: 30 mg/kg/day PO divided BID/QID, max 1g/day

Special Populations

  • Pregnancy Rating: D
  • Lactation risk: Infant risk cannot be ruled out
  • Renal dosing: avoid in moderate to severe renal impairment
  • Hepatic dosing: no adjustment


  • Allergy to class/drug
  • Pregnancy
  • History of penicillamine-related aplastic anemia or agranulocytosis
  • Rheumatoid arthritis with renal insufficiency

Adverse Reactions


  • SJS/TEN, pemphigus
  • Agranulocytosis, aplastic anemia, thrombocytopenia, TTP, ALL
  • Liver failure, toxic hepatitis, cholestatic hepatitis, pancreatitis
  • Renal failure, renal vasculitis, nephrotic syndrome
  • Myasthenia gravis, optic neuritis
  • Extrinsic allergic alveolitis, interstitial pneumonia, obliterative bronchiolitis
  • Drug fever



  • Half-life: 4-6 days
  • Metabolism: Hepatic
  • Excretion: Renal (50%) and fecal (30%)

Mechanism of Action

  • As chelator: binds to heavy metals to form stable, soluble complexes that are readily excreted in the urine
  • Anti-rheumatic: Mechanism unknown


See Also