Last update Sept. 23, 2023

Penicillamine

Decreased level of risk

New scientific evidences have driven the Apilam staff to update the level of risk associated to this product.
Former level of risk, which was Possibly safe. Probably compatible. Mild risk possible. Follow up recommended. Read the Comment., is now set to Safe. Compatible. Minimal risk for breastfeeding and infant.

Level of risk reviewed on Sept. 23, 2023

Very Low Risk

Safe. Compatible. Minimal risk for breastfeeding and infant.

A chelating agent that helps remove heavy metals such as copper, lead and mercury from the body. Used to treat Wilson's disease, cystinuria, severe rheumatoid arthritis and chronic active hepatitis.

It is excreted in breast milk in no or no detectable amount (Kodama 2021, Izumi 2012), and no clinical or analytical problems (Cu, Zn) have been observed in infants whose mothers took it. (Kodama 2021, Reuner 2019, Sternlieb 2000, Messner 1998, Bunke 1989, Gregory 1983)

Oral bioavailability decreases by half in the presence of food, so its passing to the infant’s plasma via ingested breast milk would be very difficult.

Copper and zinc levels in breast milk of mothers treated with penicillamine, trientine or zinc are normal according to more recent studies (Kodama 2021) and lower than normal according to older ones. (Bunke 1989)

Cases of breast hyperplasia and hyperprolactinemia have been reported in patients treated with penicillamine. (Craig 1988, Kahl 1985, Thew 1980)

Alternatives

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Penicillamine is also known as


Penicillamine in other languages or writings:

Tradenames

Main tradenames from several countries containing Penicillamine in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 40 - 70 %
Molecular weight 149 daltons
Protein Binding > 80 %
VD 0.8 l/Kg
pKa 2.56 -
Tmax 1 - 3 hours
1 - 3 hours
M/P ratio 0 -
Theoretical Dose 0 mg/Kg/d
Relative Dose 0 %

References

  1. Kodama H, Anan Y, Izumi Y, Sato Y, Ogra Y. Copper and zinc concentrations in the breast milk of mothers undergoing treatment for Wilson's disease: a prospective study. BMJ Paediatr Open. 2021 Jun 17;5(1):e000948. Abstract
  2. Reuner U, Dinger J. Pregnancy and Wilson disease: management and outcome of mother and newborns-experiences of a perinatal centre. Ann Transl Med. 2019 Apr;7(Suppl 2):S56. Abstract
  3. Izumi Y. Can mothers with Wilson's disease give her breast milk to their infant? Teikyo Med J. 2012;35:17-24. 2012 Full text (link to original source) Full text (in our servers)
  4. Mahadevan U, Kane S. American gastroenterological association institute technical review on the use of gastrointestinal medications in pregnancy. Gastroenterology. 2006 Jul;131(1):283-311. Review. Abstract Full text (link to original source) Full text (in our servers)
  5. Merck. Penicillamine. Drug Summary. 2004 Full text (in our servers)
  6. Sternlieb I. Wilson's disease and pregnancy. Hepatology. 2000 Abstract Full text (link to original source) Full text (in our servers)
  7. Messner U, Günter HH, Niesert S. [Wilson disease and pregnancy. Review of the literature and case report]. Z Geburtshilfe Neonatol. 1998 Abstract
  8. Ostensen M. Treatment with immunosuppressive and disease modifying drugs during pregnancy and lactation. Am J Reprod Immunol. 1992 Abstract
  9. Bunke H, Cario WR, Schneider M. [Variations in the composition of breast milk in Wilson's disease]. Kinderarztl Prax. 1989 Abstract
  10. Craig HR. Penicillamine induced mammary hyperplasia: report of a case and review of the literature. J Rheumatol. 1988 Abstract
  11. Kahl LE, Medsger TA Jr, Klein I. Massive breast enlargement in a patient receiving D-penicillamine for systemic sclerosis. J Rheumatol. 1985 Abstract
  12. Gregory MC, Mansell MA. Pregnancy and cystinuria. Lancet. 1983 Abstract
  13. Thew DC, Stewart IM. D penicillamine and breast enlargement. Ann Rheum Dis. 1980 Abstract

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