FM1997

Disease Modifying Drugs > Penicillamine

 
Dosage Start at 125mg nocte
Increase by 125mg nocte evry 4 weeks until response.
Usual maximum dose is 625mg nocte

Must be taken on an EMPTY stomach. Do NOT take oral iron within 8 hours

Investigations before starting treatment performed by rheumatologist

Monitoring of treatment by primary health care team

 
Investigation Frequency Action required
FBC Every 2 weeks for 3 months and then monthly
STOP if: WBC <4 x 109/L
neutrophils <2 x 109/L
platelets <150 x 109/L
OR if: sequential fall of >10% in 3 counts
Urinalysis Every 2 weeks for 3 months and then monthly
STOP if: proteinuria + or haematuria +
unless MSU shows infection

Please note that in addition to absolute values for haematological indices a rapid fall
or consistent downward trend  in any values should prompt caution and extra vigilance.

Side effects

 
Rash, mouth ulcers STOP if more than slight
Dyspnoea or muscle weakness STOP
Nausea Reduce dose - if persistent seek advice
Loss of taste/metallic taste Continue - disappears after 3 months

 

These guidelines have been with permission from the department of rheumatology, Gwent Rheumatology Service.

 

 
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Francisco Machado 1997