Pharmacology. Penicillamine is a derivative of penicillin that has no antimicrobial activity but effectively chelates some heavy metals, such as lead, mercury, and copper. It has been used as adjunctive therapy after initial treatment with calcium EDTA (See EDTA, Calcium (Calcium Disodium EDTA, Calcium Disodium Edetate, Calcium Disodium Versenate)) or BAL (dimercaprol [See BAL (Dimercaprol)]), although it largely has been replaced by the oral chelator succimer (DMSA [See Succimer (DMSA)]) because of its poor safety profile. Penicillamine is well absorbed orally, and the penicillamine-metal complex is eliminated in the urine. No parenteral form is available.

Indications

1. 
   

   Penicillamine may be used to treat heavy metal poisoning caused by lead (if the patient cannot tolerate succimer, penicillamine may be used alone for minor intoxication or as adjunctive therapy after calcium EDTA or BAL in moderate to severe intoxication), mercury (after initial BAL therapy and if the patient cannot tolerate succimer), and copper (succimer may be an alternative for mild to moderate poisoning). Penicillamine has also been used for arsenic, bismuth, and nickel poisoning, but it is not the agent of choice owing to its toxicity.

   
   
2. 
   

   For lead or mercury poisoning, oral succimer (See Succimer (DMSA)) is preferable, as it may result in greater metal excretion with fewer adverse effects.

   
   
3. 
   

   For copper poisoning (See Copper

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