Cuprimine (penicillamine)
Also marketed as Depen. An approved treatment for Wilson Disease.
Drug facts
The same compound appears under different names depending on the context. Here is how to identify Penicillamine wherever you encounter it, plus the key facts at a glance.
- Generic name
- Penicillamine
- Brand names
- Cuprimine, Depen
- Drug class
- Copper chelator (oral)
- Manufacturer
- Bausch Health (Cuprimine); Viatris (Depen); generic available
- How it's taken
- Taken by mouth on an empty stomach.
The original copper chelator for Wilson disease, in clinical use since the 1950s.
Highly effective at removing copper but limited by a substantial side effect burden, which has driven decades of effort to develop better-tolerated alternatives. Still widely used for initial de-coppering in many centers.
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Where Penicillamine fits
Historical first-line de-coppering agent.
- Many centers now consider trientine (Cuvrior or Syprine/generic) or zinc as alternatives or first-line options for selected patients given penicillamine's tolerability profile, but penicillamine remains a standard option, particularly during the initial de-coppering phase.
How Penicillamine works
Oral copper chelator that binds copper and other heavy metals so they can be excreted in the urine. Penicillamine has been the historical first-line de-coppering agent for Wilson disease since the 1950s.
Side effects and safety
Penicillamine has one of the broader side effect profiles in Wilson disease therapy. Common effects include rash, fever, lymphadenopathy, taste changes, and gastrointestinal upset, especially during initiation. Important serious effects include bone marrow suppression (cytopenias, requiring CBC monitoring), proteinuria from membranous nephropathy, drug-induced lupus and other autoimmune syndromes, myasthenia gravis, and pyridoxine (vitamin B6) deficiency that requires routine supplementation.
Paradoxical worsening of neurologic symptoms during the first weeks of therapy can occur in patients with neurologic Wilson disease. Penicillamine has a boxed warning: it should never be used casually, every patient should stay under close supervision by a doctor who knows its risks, and any sign of a side effect should be reported right away.
The label says deaths have occurred from aplastic anemia, agranulocytosis, low platelets, Goodpasture's syndrome (a kidney and lung disease) and myasthenia gravis. Urine tests and blood counts are done twice a week for the first month, every 2 weeks for the next 5 months, then monthly, and fever, sore throat, chills, bruising or bleeding should be reported right away.
People who had aplastic anemia or agranulocytosis from penicillamine should not take it again. The label also warns about liver injury (liver tests every 3 months in the first year for Wilson disease), pemphigus (a serious blistering skin disease), a rare lung disease called obliterative bronchiolitis, and possible harm to an unborn baby.
This is not a complete list of side effects. Talk to your doctor or pharmacist about what to expect and when to seek medical attention.
Taking Penicillamine
Taken by mouth on an empty stomach. Adult de-coppering doses are typically 1000 to 1500mg per day divided into 2 to 4 doses (AASLD), lowered to a maintenance dose (often 750 to 1000mg per day) once de-coppering is achieved. The label says people with Wilson disease should take 25mg of pyridoxine (vitamin B6) a day during treatment, because penicillamine raises the need for it.
Take penicillamine at least 1 hour before or 2 hours after meals, and at least 1 hour apart from other medicines, food, milk, antacids, zinc or iron.
Availability and cost
Generic versions may be available at a lower cost. Ask your pharmacist.
Help paying for Cuprimine
The maker of Cuprimine publishes no copay card; the offers below are what its official pages list. Drugmaker copay cards can't be used with Medicare, Medicaid or TRICARE, but charity funds often can. None of the 2 charity funds for Wilson Disease were open on October 26, 2026. Without insurance, you can apply to the drugmaker's free medicine program, which sets its own eligibility rules. Pick your insurance below to see which offers fit you.
- Free medicine program
Brand CUPRIMINE is on the Bausch Health PAP list. Free medicine for eligible patients with limited or no coverage, shipped to your home at no cost for up to 12 months. Requirements include being a legal US resident and outpatient with a valid prescription, and household income at or below 300% of the Federal Poverty Level. Applicants must lack coverage or have exhausted appeals through government programs. If you appear eligible for Medicare Part D Low-Income Subsidy, you must apply for it first. Some forms or strengths may not be covered.
For: no insurance, underinsured, Medicaid · source
Good to know: Applies to brand CUPRIMINE only; generic penicillamine and DEPEN (Viatris) are not covered. Phone hours are Monday to Friday, 8 AM to 8 PM ET. A WD Rx Access copay form exists, but its posted terms expired, so current copay help is unconfirmed.
Charity funds for Wilson Disease
- From a charity · Wilson Disease AssociationWDA Patient Assistance fundApply directly
Pays for: Travel and lodging (up to 7 days) for testing or treatment, for the patient and one companion, up to $2,000 per year.
The foundation says: “Status not shown on page”
How Wilson disease treatments compare
Four FDA-approved medications are available for Wilson disease, plus investigational programs at different stages. Treatment choice depends on your stage (active de-coppering versus stable maintenance), your tolerance to penicillamine, whether you have neurologic or hepatic features, and your age. This chart summarizes the practical differences between the approved options.
Wilson Disease has 4 FDA-approved treatments: Cuprimine / Depen (penicillamine, approved 1970); Syprine (trientine hydrochloride, approved 1985); Galzin (zinc acetate, approved 1997); Cuvrior (trientine tetrahydrochloride, approved 2022). Cuprimine / Depen is typically used as approved for wilson disease in general. carries a boxed warning and needs frequent blood and urine tests, twice a week in the first month on the cuprimine label..
| Drug | How it works | How it’s given | How often | Where you take it | Typical use | FDA approved |
|---|---|---|---|---|---|---|
Cuprimine / Depen penicillamine You are here | Copper chelator that binds copper in the body so it leaves in the urine. The original Wilson disease drug. | Oral capsule or tablet, taken on an empty stomach | 1,000 to 1,500mg a day in 2 to 4 doses to start, 750 to 1,000mg for maintenance (AASLD) | Home (oral) | Approved for Wilson disease in general. Carries a boxed warning and needs frequent blood and urine tests, twice a week in the first month on the Cuprimine label. | 1970 |
Syprine trientine hydrochloride | Copper chelator that binds copper so it leaves in the urine. No trial has compared it head to head with penicillamine as a first treatment (AASLD). | Oral capsule, taken on an empty stomach (capsules require refrigeration) | 2 to 4 times daily | Home (oral) | Approved for patients who cannot tolerate penicillamine. Generic versions are available. | 1985 |
Galzin zinc acetate | Copper absorption blocker. It makes gut cells produce a protein (metallothionein) that traps copper from food before it can be absorbed. | Oral capsule, taken on an empty stomach | 3 times daily | Home (oral) | Approved for maintenance after a person has first been treated with a chelator; not for the first treatment of someone with symptoms. | 1997 |
Cuvrior trientine tetrahydrochloride | Copper chelator with the same action as Syprine, in a more stable salt that is stored at room temperature and taken twice a day. | Oral tablet, taken on an empty stomach | Twice daily | Home (oral) | Approved for adults with stable Wilson disease who are de-coppered and tolerant to penicillamine; designed as a maintenance switch option. | 2022 |
This chart summarizes approved Wilson disease treatments to help you understand your options. It is not medical advice. Treatment decisions depend on your individual disease stage, prior therapies, tolerability, and lab values for copper control. Investigational programs (ALXN1840, UX701, PM577a) are not included because they are not FDA-approved. Always discuss options with your hepatologist or metabolic specialist.
Development history
Penicillamine was first reported as a copper chelator by John Walshe in 1956 and transformed Wilson disease from a fatal disease into a treatable one. It remained the main Wilson disease drug until trientine hydrochloride (Syprine) was approved in 1985, and is still in routine use today.
Explore Wilson Disease trials
Other Wilson Disease treatments
Common questions about Penicillamine
▸What is Penicillamine (Cuprimine)?
The original copper chelator for Wilson disease, in clinical use since the 1950s. Highly effective at removing copper but limited by a substantial side effect burden, which has driven decades of effort to develop better-tolerated alternatives. Still widely used for initial de-coppering in many centers.
▸What is the mechanism of action of Penicillamine?
Oral copper chelator that binds copper and other heavy metals so they can be excreted in the urine. Penicillamine has been the historical first-line de-coppering agent for Wilson disease since the 1950s.
▸What are the side effects of Penicillamine?
Penicillamine has one of the broader side effect profiles in Wilson disease therapy. Common effects include rash, fever, lymphadenopathy, taste changes, and gastrointestinal upset, especially during initiation. Important serious effects include bone marrow suppression (cytopenias, requiring CBC monitoring), proteinuria from membranous nephropathy, drug-induced lupus and other autoimmune syndromes, myasthenia gravis, and pyridoxine (vitamin B6) deficiency that requires routine supplementation. Paradoxical worsening of neurologic symptoms during the first weeks of therapy can occur in patients with neurologic Wilson disease. Penicillamine has a boxed warning: it should never be used casually, every patient should stay under close supervision by a doctor who knows its risks, and any sign of a side effect should be reported right away. The label says deaths have occurred from aplastic anemia, agranulocytosis, low platelets, Goodpasture's syndrome (a kidney and lung disease) and myasthenia gravis. Urine tests and blood counts are done twice a week for the first month, every 2 weeks for the next 5 months, then monthly, and fever, sore throat, chills, bruising or bleeding should be reported right away. People who had aplastic anemia or agranulocytosis from penicillamine should not take it again. The label also warns about liver injury (liver tests every 3 months in the first year for Wilson disease), pemphigus (a serious blistering skin disease), a rare lung disease called obliterative bronchiolitis, and possible harm to an unborn baby.
▸How is Penicillamine taken?
Taken by mouth on an empty stomach. Adult de-coppering doses are typically 1000 to 1500mg per day divided into 2 to 4 doses (AASLD), lowered to a maintenance dose (often 750 to 1000mg per day) once de-coppering is achieved. The label says people with Wilson disease should take 25mg of pyridoxine (vitamin B6) a day during treatment, because penicillamine raises the need for it. Take penicillamine at least 1 hour before or 2 hours after meals, and at least 1 hour apart from other medicines, food, milk, antacids, zinc or iron.
▸Is Penicillamine FDA approved?
Yes, Penicillamine (Cuprimine) is FDA approved (1970) for the treatment of Wilson Disease.
▸What is penicillamine used for in Wilson disease?
Penicillamine (Cuprimine, Depen) is the original copper chelator for Wilson disease, in clinical use since the 1950s and first reported as a copper chelator by John Walshe in 1956. It is highly effective at removing copper and is still widely used for initial de-coppering in many centers, though its side effect burden has led many centers to consider trientine or zinc as alternatives for selected patients.
▸How is penicillamine taken?
Penicillamine is taken by mouth on an empty stomach, at least 1 hour before or 2 hours after meals and at least 1 hour apart from other medicines, food, milk, antacids, zinc or iron. Adult de-coppering doses are typically 1000 to 1500mg per day divided into 2 to 4 doses (AASLD), lowered to a maintenance dose of often 750 to 1000mg per day once de-coppering is achieved. People with Wilson disease should also take 25mg of pyridoxine (vitamin B6) a day during treatment.
▸What are the side effects of penicillamine?
Common side effects of penicillamine include rash, fever, swollen lymph nodes, taste changes, and gastrointestinal upset, especially when starting. Serious effects include bone marrow suppression, kidney protein loss from membranous nephropathy, drug-induced lupus, myasthenia gravis, liver injury, pemphigus, and vitamin B6 deficiency, and paradoxical worsening of neurologic symptoms can occur in the first weeks of therapy. Penicillamine carries a boxed warning, and the label reports deaths from aplastic anemia, agranulocytosis, low platelets, Goodpasture's syndrome and myasthenia gravis.
▸What monitoring is needed while taking penicillamine?
Because of its boxed warning, every patient on penicillamine should stay under close supervision by a doctor who knows its risks. Urine tests and blood counts are done twice a week for the first month, every 2 weeks for the next 5 months, then monthly, and liver tests are done every 3 months in the first year for Wilson disease. Fever, sore throat, chills, bruising or bleeding should be reported right away, and anyone who had aplastic anemia or agranulocytosis from penicillamine should not take it again.