When This Medicine Should Not Be Used:
Make sure your doctor knows if you have had an allergic reaction to any chelating agent such as penicillamine, succimer, or trientine. Make sure your doctor knows if you are pregnant or breastfeeding. Tell your doctor if you have kidney disease.

How to Use This Medicine:
Capsule, Tablet

• Your doctor will tell you how much medicine to use. Do not use more than directed.
• Carefully follow your doctor's instructions about any special diet.
• You might need to take this medicine on an empty stomach. Take penicillamine or trientine at least 1 hour before eating a meal or 2 hours after eating a meal. Do not eat or drink milk within 1 hour of the time you take this medicine. Ask your doctor or pharmacist if you have questions about what schedule to follow.
• If you cannot swallow the succimer capsule, you may open it and pour the medicine into a small amount of soft food such as pudding, yogurt, or applesauce. Stir this mixture well and swallow it without chewing. You can also pour the medicine beads into a spoon, swallow the beads, and then drink some fruit drink.
• Do not open or chew trientine capsule. If you get any of this medicine on your skin, wash it off right away.
• You might need to drink extra water while you are using this medicine.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Make sure your doctor knows if you are also using any other medicines to lower the amount of metal in your body.
• Tell your doctor if you are also using any vitamin, mineral, or iron supplements.
• Do not take any other medicine at the same time you take penicillamine. Always allow at least 1 hour between the time you take penicillamine and the time you take other medicines. If you are using a different chelating medicine, ask your doctor.
• Make sure your doctor knows if you are also using phenylbutazone or medicine to treat malaria, such as mefloquine, quinine, quinidine, chloroquine, atovaquone/proguanil, Lariam®, Malarone®, Aralen®.

Warnings While Using This Medicine:

• Make sure your doctor knows if you are pregnant or breastfeeding, or if you have kidney disease, liver disease, or problems with your blood. Tell your doctor if you are allergic to penicillin.
• Your doctor will do lab tests at regular visits to check on the effects of this medicine. Keep all appointments.
• Do not stop using this medicine without talking to your doctor first.
• Make sure any doctor or dentist who treats you knows that you are using this medicine.
• Tell your doctor if you have ever used a chelating agent before.
• Some people have too much heavy metal in their bodies because they were exposed to it, such as in the home or at work. The metal could still be in their surroundings. If this is your situation, then you must get rid of the metal or learn how to protect yourself. This medicine will not protect you from a heavy metal that you are still being exposed to. Find out how you were exposed. Ask your health caregiver about the best ways to get rid of or avoid the heavy metal that caused the problem.
• For Wilson's disease, you might need to use this medicine for one to three months before you notice any improvement. The symptoms of Wilson's disease might get worse when you first start using this medicine. If your symptoms get very bad or keep getting worse, tell your doctor.
• For people who have diabetes: Succimer may affect the results of some urine tests for ketones (such as Ketostix®). Ask your doctor what kind of ketone test you should use while you are using succimer.
• Your skin might be more fragile while you are using penicillamine, especially on your shoulders, elbows, knees, toes, or buttocks. Your skin might also heal more slowly than usual. Talk to your doctor before you have any kind of surgery, because your dose of this medicine might need to be changed.
• You might need to take your temperature every night when you first start using this medicine.

Possible Side Effects While Using This Medicine:
Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Bloody or cloudy urine.
• Fever, by itself or with chills or sore throat.
• Muscle weakness, drooping eyelids, double vision, trouble seeing.
• Numbness, tingling, or burning pain in your hands, arms, legs, or feet.
• Scaly, red, or flaky patches on your skin, or skin blisters (especially in your mouth).
• Seizures, clumsiness.
• Skin rash, itching, redness (at any time during treatment, or after treatment stops).
• Trouble breathing, coughing up blood, unexplained cough or wheezing.
• Unusual bleeding, bruising, or weakness.

If you notice these less serious side effects, talk with your doctor:

• Dizziness, sleepiness.
• Metallic taste in your mouth.
• Nausea, vomiting, diarrhea, stomach pain, loss of appetite or ability to taste.
• Ringing in your ears.
• Skin wrinkles, small white spots.
• Sores, swelling, cracks, or white patches on your lips, mouth, or throat.
• Unusual muscle pain, or joint pain or swelling.

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088