Penicillamine

Drug Levels and Effects:




Summary of Use during Lactation:


Limited information indicates that penicillamine is not detectable in breastmilk. Copper andzinclevels in breastmilk are reduced in mothers receiving penicillamine.[1][2][3][4][5] Penicillamine has been used with apparent safety during nursing of 3 infants. In infants who breastfeed infrequently, taking the drug right after nursing and waiting 4 to 6 hours before nursing again should minimize the amount of penicillamine in breastmilk. Copper andzinclevels in breastmilk are reduced in patients taking penicillamine. The implications for infants of this effect are not known.


Drug Levels:


Maternal Levels.

Four patients received penicillamine for Wilson's disease in dosages of 800, 600 (2 patients) and 500 mg daily. Penicillamine was not detectable by HPLC in the breastmilk of any of the mothers' milk samples.[4]

Infant Levels.

Relevant published information was not found as of the revision date.


Effects in Breastfed Infants:


One woman taking penicillamine 1500 mg daily for cysteinuria breastfed her infant for 3 months with no apparent adverse effects in her infant.[6]

Another woman breastfed 2 infants after 2 pregnancies while being treated for Wilson's disease with penicilliamine 750 mg daily. One infant had prolonged icterus that was unlikely to have been related to the penicillamine.[7]


Possible Effects on Lactation:


Milk concentrations ofzincand copper are reduced during therapy of Wilson's disease with penicillamine.[3][7][8][9]


Alternate Drugs to Consider:


(Rheumatoid Arthritis) Auranofin,Etanercept,Gold Sodium Thiomalate,Hydroxychloroquine,Infliximab,Methotrexate,Sulfasalazine,(Wilson's disease) Trientine


References:


1. Byron MA. Treatment of rheumatic diseases. Br Med J. 1987;294:236-8. PMID:3101825
2. Ramsey-Goldman R, Schilling E. Optimum use of disease-modifying and immunosuppressive antirheumatic agents during pregnancy and lactation. Clin Immunother. 1996;5:40-58.
3. Shiga K, Kaga H, Kodama H et al. Copper andzincconcentrations in the breast milk of mothers with Wilson disease and effects on infants. J Inherit Metab Dis. 2006;29 Suppl. 1:139. Abstract.
4. Izumi Y. [Can mothers with Wilson's disease give her breast milk to their infant?]. Teikyo Med J. 2012;35:17-24.
5. Kaga F, Kodama H, Siga K et al. Copper andzincstatus in the breast milk of mothers with Wilson disease. J Inherit Metab Dis 2008;31 (Suppl. 1):157. Abstract.
6. Gregory MC, Mansell MA. Pregnancy and cystinuria. Lancet. 1983;2:1158-60. PMID:6139526
7. Messner U, Gunter HH, Niesert S. [Wilson disease and pregnancy. Review of the literature and case report]. Z Geburtshilfe Neonatol. 1998;202:77-9. PMID:9654718



Substance Identification:




Substance Name:

Penicillamine

CAS Registry Number:

52-67-5

Drug Class:


  • Antirheumatic Agents


  • Administrative Information:




    LactMed Record Number:


    208


    Last Revision Date:


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