페니실라민
Penicillamine
D-Penicillamine, beta,beta-Dimethylcysteine, D-3-Mercaptovaline
다른 이름: Depen · Cuprimine · Pendramine · D-Penicillamine · beta,beta-Dimethylcysteine · D-3-Mercaptovaline · penicillaminum
VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
동물 종별 용량
🌎 NA — North America🌍 EU — Europe
개
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Copper-associated hepatopathy | 10-15 mg/kg PO q12h on an empty stomach. Do not give concurrently with any medication, including zinc or a vitamin-mineral supplement. | PO | q12h | — | 🌎 NA |
| Copper-associated hepatopathy | 15 mg/kg PO twice daily 30 minutes before meals. Give supplemental pyridoxine. Chelate at least 6 months, and then use a second liver biopsy to determine efficacy and chronic treatment plan. | PO | q12h | At least 6 months | 🌎 NA |
| Copper-associated hepatopathy | 10-15 mg/kg PO two times a day 30 minutes prior to food. Start low and increase. | PO | q12h | — | 🌎 NA |
| Copper-associated hepatopathy | 15 mg/kg PO twice daily on an empty stomach. | PO | q12h | — | 🌎 NA |
| Cystine urolithiasis | 15 mg/kg: PO twice daily. If nausea and vomiting occur, mix with food or give at mealtime. Some dogs may need to have the dosage slowly increased to full dose in order to tolerate the drug. | PO | q12h | — | 🌎 NA |
| Cystine urolithiasis | 15 mg/kg: PO twice daily with food | PO | q12h | — | 🌎 NA |
| Lead poisoning | 110 mg/kg/day, PO divided q6-8h for 1-2 weeks. If vomiting, depression, and anorexia occur, may reduce dose to 33-55 mg/kg/day divided q6-8h, which should be better tolerated. | PO | q6-8h | 1-2 weeks | 🌎 NA |
| Lead poisoning | 110 mg/kg/day divided q6-8h PO 30 minutes before feeding for 1-2 weeks. If vomiting a problem may premedicate with dimenhydrinate (2-4 mg/kg PO). Alternatively, may give 33-55 mg/kg/day divided as above. | PO | q6-8h | 1-2 weeks | 🌎 NA |
| Copper storage disease / Copper-associated hepatopathy | Dose not specified in monograph | PO | Not specified | Long-term (weeks to months) | 🌍 EU |
| Cystinuria | Dose not specified in monograph | PO | Not specified | Not specified | 🌍 EU |
| Lead toxicity | Dose not specified in monograph | PO | Not specified | Long-term | 🌍 EU |
- Copper-associated hepatopathy: If patient is zinc intolerant, use chronic penicillamine at a dose restriction of 50%. Do not use chelation and zinc together.
- Lead poisoning: After initial therapy regimen with CaEDTA and if continued therapy is desired at home.
- Lead poisoning: As an alternate or adjunct to CaEDTA. Dissolving medication in juice may facilitate administration.
- Copper storage disease / Copper-associated hepatopathy: Not helpful in an acute crisis. Pretreat with antiemetics 30-60 mins before if poorly tolerated.
- Cystinuria: Decreases cystine excretion by forming soluble complex.
- Lead toxicity: Used when injecting EDTA is too difficult or long-term chelation is required.
고양이
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Lead poisoning | 125 mg q12h PO for 5 days. | PO | q12h | 5 days | 🌎 NA |
- Lead poisoning: After initial therapy with CaEDTA and if blood lead is greater than 0.2 ppm at 3-4 weeks post-treatment.
새
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Adjunctive treatment of lead poisoning | 55 mg/kg PO q12h for 1-2 weeks. | PO | q12h | 1-2 weeks | 🌎 NA |
- Adjunctive treatment of lead poisoning: Suggested to combine CaEDTA and penicillamine for several days until symptoms dissipate followed by a 3-6 week treatment with penicillamine.
소
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Lead or mercury toxicity | 110 mg/kg PO for 1-3 weeks. | PO | Unknown | 1-3 weeks | 🌎 NA |
- Lead or mercury toxicity: To prevent continued metal absorption, must clear GI tract of toxic metal before therapy. FARAD recommends a minimum milk withdrawal time of 3 days after the last treatment and a 21-day preslaughter withdrawal.
양
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Copper toxicity | 52 mg/kg daily for 6 days | PO | q24h | 6 days | 🌎 NA |
| Copper toxicity | 26-52 mg/kg PO once daily for 6 days. | PO | q24h | 6 days | 🌎 NA |
| Lead or mercury toxicity | 110 mg/kg PO for 1-3 weeks. | PO | Unknown | 1-3 weeks | 🌎 NA |
- Copper toxicity: FARAD recommends a minimum milk withdrawal time of 3 days after the last treatment and a 21-day preslaughter withdrawal.
- Lead or mercury toxicity: Must clear GI tract of toxic metal before therapy.
염소
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Copper toxicity | 52 mg/kg daily for 6 days | PO | q24h | 6 days | 🌎 NA |
| Copper toxicity | 26-52 mg/kg PO once daily for 6 days. | PO | q24h | 6 days | 🌎 NA |
| Lead or mercury toxicity | 110 mg/kg PO for 1-3 weeks. | PO | Unknown | 1-3 weeks | 🌎 NA |
- Copper toxicity: FARAD recommends a minimum milk withdrawal time of 3 days after the last treatment and a 21-day preslaughter withdrawal.
- Lead or mercury toxicity: Must clear GI tract of toxic metal before therapy.
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
개요
페니실라민은 강력한 킬레이트제로, 수의학에서는 주로 베들링턴 테리어, 래브라도 리트리버 등에서 발생하는 구리 축적성 간질환의 관리에 사용됩니다. 또한 납이나 수은 중독의 장기 경구 치료 및 시스틴 요석증의 용해 및 예방에도 효과적입니다. 항섬유화 특성이 있어 만성 간염에 도움이 될 수 있으나, 요구되는 용량은 종종 내약성이 떨어집니다.
작용 기전
Penicillamine exerts its effects through multiple distinct mechanisms depending on the target condition:
- Heavy Metal Chelation: Contains sulfhydryl groups that bind to heavy metals (copper, lead, iron, mercury) → forms stable, water-soluble complexes → facilitates rapid excretion via the kidneys.
- Cystine Urolithiasis: Combines chemically with cystine via a disulfide interchange reaction → forms a stable, highly soluble penicillamine-cysteine mixed disulfide complex → readily excreted in urine, preventing stone formation.
- Antirheumatic Activity: Mechanism is not fully elucidated, but it improves lymphocyte function and decreases IgM rheumatoid factor and immune complexes in serum and synovial fluid.
- Antifibrotic Activity: Inhibits lysyl oxidase and collagen crosslinking → renders newly synthesized collagen more susceptible to enzymatic degradation.
안전성·주의사항
금기사항
- Patients with a history of penicillamine-related blood dyscrasias
- Presence of lead in the gastrointestinal tract (can enhance absorption)
- Pregnancy (unless benefits outweigh teratogenic risks)
- Moderate to marked renal impairment
부작용
- Nausea
- Vomiting
- Depression
- Anorexia
- Dietary mineral deficiencies (zinc, iron, copper, calcium) with long-term use
- Fever (rare)
- Lymphadenopathy (rare)
- Skin hypersensitivity reactions (rare)
- Immune-complex glomerulonephropathy (rare)
- Teratogenicity
- Pyrexia
- Nephrotic syndrome
- Leucopenia (human data)
- Thrombocytopenia (human data)
- Lymphadenopathy (human data)
- Skin hypersensitivity reactions (human data)
- Lupus-like reactions (human data)
주의
Penicillamine is contraindicated in patients with a history of penicillamine-related blood dyscrasias. Warning: Penicillamine potentially can cause enhanced absorption of lead from the gastrointestinal tract. If lead is still present in the gut (e.g., visible on radiographs), it should NOT be administered until the GI tract is cleared. Use with caution in pregnant animals due to known teratogenic potential (FDA Category D).
약물 상호작용
Concomitant administration may increase the risks for severe dermatologic adverse effects.
May decrease the effectiveness of penicillamine if given orally together due to chelation in the gut.
The amount of penicillamine absorbed from the GI tract may be reduced by concurrent administration.
May increase the risk of hematologic and/or renal adverse reactions.
May increase the risk of hematologic and/or renal adverse reactions.
May increase the risk of hematologic and/or renal adverse reactions.
Decreased gastrointestinal absorption of penicillamine
Decreased gastrointestinal absorption of penicillamine
Decreased gastrointestinal absorption of penicillamine
Decreased gastrointestinal absorption of penicillamine
Increased renal and haematological adverse effects
Increased risk of renal damage
Increased risk of renal damage
모니터링
- Clinical efficacy (e.g., resolution of neurologic signs in lead poisoning)
- Liver enzymes (ALT) and liver copper levels via biopsy (for hepatopathy)
- Urinalysis and stone dissolution (for cystine urolithiasis)
- Complete blood count (CBC) and urinalysis to monitor for rare blood dyscrasias or glomerulonephropathy
- Full blood count (weekly initially)
- Urinalysis (weekly initially)
- Renal function
- Dietary mineral levels (zinc, iron, copper, calcium) during long-term use
약동학
흡수
In humans, well absorbed after oral administration. Peak serum levels occur about one hour after dosing. Food decreases bioavailability.
분포
Crosses the placenta. Otherwise, little information is known about its distribution.
대사
Penicillamine that is not complexed with either a metal or cystine is thought to be metabolized by the liver.
배설
Excreted in the urine and feces.
과다투여
No specific acute toxic dose has been established for penicillamine. Toxic effects generally occur in patients taking the drug chronically. Any relationship of toxicity to dose is unclear; patients on small doses may develop toxicity. Management of overdose would be largely supportive and symptomatic.
제품
제형
- Titratable Oral Tablets: 250 mg
- Oral Capsules: 125 mg, 250 mg
- 125 mg oral tablet
- 250 mg oral tablet
동물용의약품
- None
인용의약품
- Penicillamine Titratable Oral Tablets: 250 mg (scored); Depen (Wallace)
- Penicillamine Oral Capsules: 125 mg & 250 mg; Cuprimine (Aton Pharma)
- Pendramine 125 mg tablets
- Pendramine 250 mg tablets
- Penicillamine 125 mg tablets
- Penicillamine 250 mg tablets
규제 현황
POM (Prescription Only Medicine)
POM (Prescription Only Medicine)
규제 데이터 없음: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
보관·안정성
Penicillamine should be stored at room temperature (15-30°C). The capsules should be stored in tight containers; tablets in well-closed containers.
보호자 정보
이 약물은 반려동물의 체내에 과도하게 축적된 금속(구리나 납 등)을 배출하거나 특정 종류의 방광 결석을 용해하는 데 사용됩니다.
- 투여 방법：약물이 제대로 흡수되도록 가급적 공복(식사 최소 30분 전)에 투여해야 합니다.
- 부작용 관리：반려동물이 구토나 식욕 부진을 보이면 수의사에게 연락하세요. 하루 복용량을 더 작게 여러 번 나누어 먹이거나, 일시적으로 용량을 줄이거나, 위장 장애를 줄이기 위해 소량의 음식(치즈나 빵 등)과 함께 먹이도록 권장할 수 있습니다.
- 비타민/미네랄 보충제(특히 아연이나 철분 함유 제품) 또는 제산제와 동시에 먹이지 마세요. 이들은 약물과 결합하여 약효를 떨어뜨릴 수 있습니다.
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