REVIEW Penicillamine is an antirheumatic drug used to treat patients with active rheumatoid arthritis. The mechanism of action of penicillamine in rheumatoid arthritis is unknown but it may be related to reduction of collagen formation. (Collagen is a type of tissue that forms a part of scar tissue that results from inflammation) and suppression of the immune system. In patients with rheumatoid arthritis, penicillamine appears to slow the progression of the disease (specifically deformities of the joints) and improve function. For this reason it is considered a disease modifying anti-rheumatic drug (DMARD). Penicillamine is also classified as a metal binding (chelating) agent used for treating Wilson''s disease, a genetic disease that causes excessive copper to accumulate in the body. Penicillamine binds copper,( and can also bind iron, mercury, lead, and cysteine) which then are excreted in the urine, and this mechanism is important in treating several nonrheumatic diseases including Wilson''s disease. Penicillamine also reduces excess cystine excretion in cystinuria. This is done, at least in part, by disulfide interchange between penicillamine and cystine, resulting in formation of penicillamine-cysteine disulfide, a substance that is much more soluble than cystine and is excreted readily. The compound has also been used as a chemopreventative agent. Penicillamine is an antirheumatic drug used to treat patients with active rheumatoid arthritis. The mechanism of action of penicillamine in rheumatoid arthritis is unknown but it may be related to reduction of collagen formation. (Collagen is a type of tissue that forms a part of scar tissue that results from inflammation) and suppression of the immune system. In patients with rheumatoid arthritis, penicillamine appears to slow the progression of the disease (specifically deformities of the joints) and improve function. For this reason it is considered a disease modifying anti-rheumatic drug (DMARD). Penicillamine is also classified as a metal binding (chelating) agent used for treating Wilson''s disease, a genetic disease that causes excessive copper to accumulate in the body. Penicillamine binds copper,( and can also bind iron, mercury, lead, and cysteine) which then are excreted in the urine, and this mechanism is important in treating several nonrheumatic diseases including Wilson''s disease. Penicillamine also reduces excess cystine excretion in cystinuria. This is done, at least in part, by disulfide interchange between penicillamine and cystine, resulting in formation of penicillamine-cysteine disulfide, a substance that is much more soluble than cystine and is excreted readily. The compound has also been used as a chemopreventative agent.
REFERENCES
[1]
WALSHE JM: Penicillamine, a new oral therapy for Wilson''s disease. Am J Med. 1956 Oct;21(4):487-95.
[2]
Walshe JM: The story of penicillamine: a difficult birth. Mov Disord. 2003 Aug;18(8):853-9.
[3]
Gong Y, Frederiksen SL, Gluud C: D-penicillamine for primary biliary cirrhosis. Cochrane Database Syst Rev. 2004 Oct 18;(4):CD004789.
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