Depen (Penicillamine)

Take DEPEN exactly as directed by your doctor. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you.

Take each dose with a full glass of water.

DEPEN must be taken on an empty stomach, at least 1 hour before or 2 hours after a full meal, and at least 1 hour before or after any other drug, food, or milk. Taking DEPEN with anything else in the stomach greatly decreases its effectiveness.

Do not stop taking DEPEN without first talking to your doctor. Stopping therapy may cause your body to react abnormally when therapy is restarted. If you do stop taking the medication, do not restart without first talking to your doctor. You may need special monitoring.

Your doctor may want you to take a vitamin and mineral supplement during treatment with DEPEN. DEPEN may reduce vitamin B6 and iron in the body. Follow your doctor's instructions.

Store DEPEN at room temperature away from moisture and heat.

Seek emergency medical attention.

Symptoms of a DEPEN overdose are not known.

Take the missed dose on an empty stomach as soon as you remember. However, if it is almost time for your next dose, skip the dose you missed and take only your next regularly scheduled dose. Do not take a double dose of this medication unless otherwise directed by your doctor. If you have missed several doses in a row, do not take any more doses without first talking to your doctor.

If you experience any of the following serious side effects, seek emergency medical attention or contact your doctor immediately:

•an allergic reaction (shortness of breath; closing of your throat; difficulty breathing; swelling of your lips, face, or tongue; or hives);

•fever or chills;

•a sore throat;

•unusual bleeding or bruising;

•blood in the urine;

•unexplained shortness of breath, coughing, or wheezing;

•abdominal pain;

•yellow skin or eyes;

•muscle weakness; or

•double vision.

Other, less serious side effects may be more likely to occur. Continue to take DEPEN and notify your doctor if you experience

•itching or a rash;

•nausea, vomiting, diarrhea, or decreased appetite;

•ringing in the ears;

•decreased taste;

•sores in the mouth;

•poor wound healing; or

•increased wrinkling of the skin.

Notify your doctor immediately if you develop fever; chills; a sore throat; unusual bruising or bleeding; blood in your urine, unexplained shortness of breath, coughing, or wheezing; muscle weakness; or double vision. These symptoms could be early signs of dangerous side effects.

You cannot take DEPEN if you have taken it in the past and it has damaged your blood cells.

Before taking DEPEN, tell your doctor if you have kidney disease or any other serious illness. You may not be able to take DEPEN, or you may require a lower dose or special monitoring during therapy.

DEPEN may cause birth defects in an unborn baby. However, it has also been used during pregnancy with no evidence of defects. DEPEN should not be used during pregnancy except to treat Wilson's disease and some cases of cystine in the urine. Do not take this medication without first talking to your doctor if you are pregnant.

It is not known whether DEPEN passes into breast milk. Since DEPEN may harm a nursing infant, breast-feeding is not recommended during treatment with this medication.

Follow any special diet restrictions recommended by your doctor.

Do not take DEPEN if you are taking any of the following medicines:

•a gold-therapy product such as auranofin (Ridaura), aurothioglucose (Solganal), or gold sodium thiomalate (Myochrysine, Aurolate);

•an antimalarial medicine such as quinine (Quinamm), mefloquine (Lariam), chloroquine (Aralen), hydroxychloroquine (Plaquenil), primaquine, or pyrimethamine (Daraprim);

•a cancer chemotherapy medicine; or

•phenylbutazone.

Like DEPEN, the medications listed above can affect the blood and the kidneys. Combined with DEPEN, any of these medicines can be very dangerous.

Before taking DEPEN, tell your doctor if you are taking digoxin (Lanoxin, Lanoxicaps). DEPEN may decrease the effects of digoxin, and your doctor may want to adjust your dosage or monitor your therapy.

Many other drugs, especially antacids and vitamin and mineral supplements, can decrease the effects of DEPEN. Do not take any medicines or over-the-counter drugs or supplements within 1 hour of a DEPEN dose.

Drugs other than those listed here may also interact with DEPEN. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.