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This document outlines critical safety information regarding the use of penicillamine (Depen). It is essential for patients and healthcare providers to understand the potential risks, necessary precautions, and specific instructions for safe use of this medication. Please read the following points carefully.

• Close Supervision Required: Regular monitoring by a healthcare provider is necessary while taking penicillamine (Depen) due to possible side effects such as blood, kidney, and skin issues. Regular lab tests and follow-up appointments are important to ensure the medication's safety. Report any side effects to your provider immediately.

• Blood Disorders: Penicillamine (Depen) may lead to serious blood-related issues, including low levels of white and red blood cells and platelets. Increased risk exists if you have a history of blood disorders or are using medications like gold therapy, antimalarials, cytotoxic drugs, oxyphenbutazone, or phenylbutazone. Regular blood tests are necessary, and any signs of fever, sore throat, chills, bruising, or bleeding should be reported to your provider promptly.

• Kidney Concerns: This medication can cause protein or blood presence in urine, indicating possible kidney damage. Those with a history of kidney problems or who are on specific medications should avoid penicillamine (Depen). Regular urine tests are essential, and any blood in urine should be reported immediately.

• Fever: A fever may develop, often in the second or third week of treatment. If this occurs, discontinue use and inform your provider. In cases of Wilson's disease or cystinuria, the provider might reintroduce the medication at a lower dose after the fever subsides.

• Allergic Reactions: Rashes can occur throughout treatment, sometimes accompanied by fever, swollen lymph nodes, or joint pain. Notify your provider if a rash develops, especially if it is itchy or persistent.

• Vitamin and Mineral Deficiency: Penicillamine (Depen) can lead to reduced vitamin B6 levels and potentially low iron, especially in children, menstruating women, or those on special diets. Consult your provider about taking supplements.

• Nerve Issues: Some users experience nerve problems, which may initially worsen but improve over time. Symptoms include drooping eyelids, double vision, and muscle weakness. Report these symptoms to your provider without delay.

• Skin Conditions: The development of pemphigus, an immune-related skin condition causing blisters and sores, has been noted. Treatment with steroids or immunosuppressants might be necessary if this occurs.

Contraindications: Penicillamine (Depen) should not be used by individuals who are currently pregnant (except for specific cases of Wilson's disease or cystinuria), breastfeeding, have a history of blood problems after using this medication, or have rheumatoid arthritis with kidney issues. Always consult your healthcare provider under these conditions.

For cases of overdose, seek emergency medical attention immediately.

When taking this medication, some individuals may experience common side effects that are generally mild and manageable. These include stomach issues such as abdominal pain, nausea, vomiting, diarrhea, or loss of appetite. A decreased sense of taste and the presence of protein in urine are also reported. Skin-related reactions like rash and hives may occur, and if these persist or worsen, it is advisable to consult your healthcare provider for guidance.

Additionally, some people may experience other effects, including fever, lupus-like symptoms (such as muscle pain, fatigue, and rash), mouth sores, or skin changes like wrinkling and flaking. There may also be occurrences of ringing in the ears, vision or movement changes, anxiety, mood issues, and changes in platelet or white blood cell counts. While these effects can be concerning, they are typically not severe but should be monitored.

However, there are rare but serious side effects that require immediate medical attention. These include signs of significant infection like persistent sore throat, fever, and swollen lymph nodes, as well as unusual bruising or bleeding. Serious allergic reactions are also rare but can manifest as rash, itching or swelling particularly of the face, tongue, or throat, severe dizziness, or trouble breathing. Kidney problems may be indicated by changes in urine output or bloody urine, and liver issues might present as persistent severe abdominal pain, dark urine, or yellowing of the eyes and skin. Should any of these severe symptoms occur, seeking medical help promptly is crucial.

Penicillamine, also known as Depen, can interact with several other medications. It's important to inform your healthcare provider about all the medications and supplements you are currently taking, including over-the-counter drugs, vitamins, and herbal products, to avoid potential interactions.

For instance, using penicillamine with medications like Digoxin, gold salts such as auranofin or gold sodium thiomalate, and certain antimalarial drugs like chloroquine, can result in interactions. These interactions may affect how the drugs work or increase the risk of side effects.

Additionally, penicillamine may interact with Phenylbutazone and other drugs that can reduce bone marrow function, such as Azathioprine, some cancer chemotherapy agents, and the antibiotic combination trimethoprim/sulfamethoxazole. These interactions could potentially increase the risk of side effects or alter drug effectiveness.

In some cases, medications like Iron might still be used with penicillamine, but your doctor may need to adjust dosages or how frequently you take each medication to manage any increased risk of side effects.

Always consult your doctor or pharmacist to understand the potential impacts of these interactions and ensure safe and effective treatment.