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The safety information below outlines critical precautions and potential risks associated with the use of penicillamine (Depen). Please ensure you understand all warnings and discuss any concerns with your healthcare provider.

• Close Monitoring Required: It is essential to be under the supervision of your healthcare provider while taking penicillamine (Depen) due to the possibility of side effects such as blood, kidney, and skin problems, as well as fever. Regular laboratory tests and follow-up visits are necessary to ensure the medication's safety. Report any side effects to your provider immediately.

• Blood Disorders: There is a risk of serious blood disorders, including low white blood cells, red blood cells, and platelets. This risk increases with concurrent use of medications such as gold therapy, antimalarial drugs, cytotoxic medications, oxyphenbutazone, or phenylbutazone. Inform your provider of any history of blood issues or if you are taking these medications. Routine blood tests are required to monitor blood cell counts. Seek medical attention if you experience fever, sore throat, chills, bruising, or bleeding.

• Kidney Issues: Penicillamine (Depen) can lead to the presence of protein or blood in the urine, indicating possible kidney damage, especially if you have a history of kidney problems or are taking specific medications. Do not use this medication if you currently have kidney issues; discuss alternatives with your provider. Regular urine tests are necessary to monitor kidney health. Immediately report any blood in your urine.

• Fever: A fever may develop, particularly within the second or third week of therapy. If fever occurs, discontinue the medication and inform your provider. For conditions like Wilson's disease or cystinuria, the provider might restart treatment at a lower dose post-fever. For rheumatoid arthritis, a medication change might be necessary.

• Allergic Reactions: Rashes can occur at any point, from the first few months up to six months or more into treatment. Notify your provider if a rash develops. A rash accompanied by fever, swollen lymph nodes, or joint pain requires immediate medical attention.

• Vitamin and Mineral Deficiency: Penicillamine (Depen) may reduce vitamin B6 levels, which is crucial for health. It may also affect protein intake in certain diets, potentially leading to low iron levels. Discuss with your provider if supplements are needed, especially for children, menstruating women, or those on low copper or methionine diets.

• Nerve Problems: Some patients experience nerve issues such as drooping eyelids, double vision, or muscle weakness, which may improve with continued treatment. Report these symptoms to your provider promptly.

• Skin Conditions: Pemphigus, an autoimmune skin condition causing blisters and sores, may occur. If symptoms appear, treatment with steroids or immunosuppressants might be necessary, and penicillamine (Depen) should be discontinued. Inform your provider if you notice any skin changes.

Contraindications: Do not use penicillamine (Depen) if you are pregnant or breastfeeding, except in specific cases involving Wilson’s disease or cystinuria. Avoid use if you have a history of blood problems from penicillamine (Depen), or if you have rheumatoid arthritis combined with kidney issues. Always consult your healthcare provider if any of these conditions apply.

When taking this medication, some common side effects may include stomach issues such as pain, nausea, vomiting, diarrhea, and a decreased appetite. A temporary loss of taste and mild rashes may also occur but are generally not serious. If these symptoms persist or worsen, it is advisable to consult your healthcare provider.

In addition to common side effects, some individuals may experience other symptoms like fever, lupus-like manifestations such as muscle pain and fatigue, hives, and various skin issues including wrinkling or flaking. Mouth sores, ringing in the ears, vision changes, movement difficulties, anxiety, and mood disturbances have also been reported. It's important to notify your doctor if these occur, particularly if they are severe.

More serious side effects, though rare, include symptoms like a significant drop in white blood cells, leading to frequent or persistent fevers, sore throat, or chills. Low platelet counts may result in easy bruising or bleeding. Kidney issues, indicated by bloody urine, and severe allergic reactions with symptoms such as rash, itching, swelling, dizziness, or trouble breathing, require immediate medical attention.

Being aware of these potential side effects can help you manage them effectively and seek timely medical advice when necessary. Always communicate with your healthcare provider about any unusual or severe symptoms you experience.

Penicillamine (Depen) can interact with several medications. It's important to inform your doctor and pharmacist about all the medications and supplements you are currently using, including prescriptions, over-the-counter drugs, vitamins, and herbal products.

Interactions to be aware of include:

1. Gold Compounds: Aurothioglucose and other gold salts like auranofin and gold sodium thiomalate may interact with penicillamine. Your doctor may avoid prescribing these together or adjust dosages accordingly due to potential interactions.

2. Bone Marrow Function Suppressants: Medications that can suppress bone marrow function, such as Azathioprine, certain cancer chemotherapies, and trimethoprim/sulfamethoxazole, might interact with penicillamine, possibly increasing the risk of side effects.

3. Digoxin: This heart medication may have interactions that require careful monitoring or dosage adjustments.

4. Malaria Treatments: Medications like chloroquine used for malaria could interact, necessitating caution and potential dosing changes.

5. Phenylbutazone: This anti-inflammatory drug may interact with penicillamine, requiring close monitoring by your healthcare provider.

6. Iron Supplements: While iron can interact with penicillamine, sometimes both are necessary for treatment. Your doctor may adjust how you take these medications to minimize interaction risks.

Always consult with healthcare professionals before making any changes to your medication regimen.