When This Medicine Should Not Be Used:
You should not use this medicine if you have ever had an allergic reaction to penicillamine, or if you are breastfeeding. Do not use this medicine if you have had blood problems caused by penicillamine in the past. The medicine should not be used by a pregnant woman unless she is being treated for Wilson's disease. You should not use this medicine for rheumatoid arthritis if you also have kidney disease.

How to Use This Medicine:
Tablet, Capsule

• Your doctor will tell you how much medicine to use. Do not use more than directed.
• It is best to take this medicine on an empty stomach, at least 1 hour before eating a meal or 2 hours after eating a meal. Do not eat food or drink milk within 1 hour of the time you take this medicine.
• Carefully follow your doctor's instructions about any special diet. This is especially important for both Wilson's disease and cystinuria.
• For cystinuria, the dose you take at bedtime is the most important dose. You should also drink plenty of water every day. You will probably need to drink at least a pint of fluid at bedtime and another pint sometime during the night. A pint is 16 ounces or 2 cups.

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 a gold compound medicine, such as auranofin, gold sodium thiomalate, Myochrysine®, Ridaura®.
• Make sure your doctor knows if you are also using phenylbutazone or medicine to treat malaria, such as mefloquine, quinine, quinidine, chloroquine, atovaquone/proguanil, Malarone®, Lariam®, Aralen®, Quinaglute®.
• Do not take iron supplements within 2 hours of the time that you take penicillamine.
• 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.
• You should not use mineral supplements while you are using penicillamine.

Warnings While Using This Medicine:

• Make sure your doctor knows if you have kidney disease or problems with your blood. Tell your doctor if you are allergic to penicillin.
• Call your doctor if you think you have become pregnant while using this medicine. If you have Wilson's disease, you and your doctor will need to decide if you should keep using this medicine during the pregnancy. For some women, it is important to keep using the medicine so the mother and baby stay healthy. If you have rheumatoid arthritis or cystinuria, you will need to stop using this medicine.
• Your doctor will do lab tests at regular visits to check on the effects of this medicine. Keep all appointments. You might also need to have other tests, such as x-rays.
• For Wilson's disease and cystinuria, 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 rheumatoid arthritis, you might still sometimes have flare-ups of arthritis symptoms. If you notice new symptoms, or your symptoms come back or get worse, tell your doctor.
• Do not stop using this medicine without talking to your doctor first. If you need to start using it again, you are more likely to have an allergic reaction.
• Your skin might be more fragile while you are using this medicine, 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.

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).
• Skin rash with fever, muscle pain, swollen glands.
• 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:

• Loss of appetite or ability to taste.
• Nausea, vomiting, diarrhea, stomach pain.
• 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