Is Penicillamine compatible with breastfeeding? Do we have alternatives for Penicillamine?

Penicillamine

June 17, 2017 (Low Risk)

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 clinically insignificant amounts (undetectable levels: Izumi 2012) and no problems have been observed in infants whose mothers have taken it (Sternlieb 2000, Messner 1998, 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 (Izumi 2012) 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

Very Low Risk

Compatible. Not risky for breastfeeding or infant.

Low Risk

Moderately safe. Mild risk possible. Follow up recommended. Read the Comment.

High Risk

Poorly safe. Evaluate carefully. Use a safer alternative. Read the Comment.

Very High Risk

Not recommended. Cessation of breastfeeding or alternative.

Synonyms

  • d-3,3-Dimethylcysteine
  • d-3-Mercaptovaline

Writings

  • πενικιλλαμίνη (Greek)
  • بينيسيلامين (Arabic)
  • Пеницилламин (Cyrillic)
  • 青霉胺 (Chinese)
  • ペニシラミン (Japanese)
  • C5H11NO2S (Molecular formula)

Drug trade names

References

  1. 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)
  2. Mahadevan U, Kane S. American gastroenterological association institute technical review on the use of gastrointestinal medications in pregnancy. Gastroenterology. 2006Abstract Full text (link to original source) Full text (in our servers)
  3. Merck. Penicillamine. Drug Summary. 2004 Full text (in our servers)
  4. Sternlieb I. Wilson's disease and pregnancy. Hepatology. 2000Abstract Full text (link to original source) Full text (in our servers)
  5. Messner U, Günter HH, Niesert S. [Wilson disease and pregnancy. Review of the literature and case report]. Z Geburtshilfe Neonatol. 1998Abstract
  6. Ostensen M. Treatment with immunosuppressive and disease modifying drugs during pregnancy and lactation. Am J Reprod Immunol. 1992Abstract
  7. Bunke H, Cario WR, Schneider M. [Variations in the composition of breast milk in Wilson's disease]. Kinderarztl Prax. 1989Abstract
  8. Craig HR. Penicillamine induced mammary hyperplasia: report of a case and review of the literature. J Rheumatol. 1988Abstract
  9. Byron MA. Treatment of rheumatic diseases. Br Med J (Clin Res Ed). 1987Abstract Full text (link to original source) Full text (in our servers)
  10. Kahl LE, Medsger TA Jr, Klein I. Massive breast enlargement in a patient receiving D-penicillamine for systemic sclerosis. J Rheumatol. 1985Abstract
  11. Gregory MC, Mansell MA. Pregnancy and cystinuria. Lancet. 1983Abstract
  12. Thew DC, Stewart IM. D penicillamine and breast enlargement. Ann Rheum Dis. 1980Abstract