Brand name : METALCAPTASE cap. 50mg  100mg  200mg 　Active ingredient: Penicillamine 　Dosage form: opaque capsule with red cap and pale yellow body 　Printings on wrapping: T651 Effects of this medicine This medicine relieves pain/stiffness in rheumatoid arthritis patients by immunomodulatory effect. It also improves the symptoms caused by heavy-metal accumulation by its effect of binding with heavy-metal such as copper, mercury or lead and draining them out of the body. It is usually used to treat rheumatoid arthritis, Wilson's disease or copper/mercury/lead intoxication. Before using this medicine, tell your doctor/pharmacist If you ever experienced any allergic reaction (itch, rash etc.) to any medicine. If you are a patient with blood disorder, renal disorder, systemic lupus erythematosus, loss of marrow function, poor general status or hepatic disorder. If you are a growing child and have metabolism disorder of connective tissue. If you are just after having surgery. If you are pregnant or breastfeeding. If you are using any other prescription or nonprescription (OTC) medicine. (It is important to reduce the risk of drug interactions.) Dosage regimen (proper use of this medicine) Your dosage regimen is:(order of your doctor) General dosage regimen: For treatment of rheumatoid arthritis, for adults, take 1 capsule (100 mg of the active ingredient) at a time, 1-3 times a day between meals on an empty stomach. The dosage should be adjusted according to your age, symptoms, tolerability or response to the medicine. Generally, start with taking 1 capsule (100 mg), increase it by 1 capsule (100 mg) at intervals of 4 weeks or more and then the maintenance dose is determined. If daily dose of 3 capsules (300 mg) is insufficient, it may be increased up to 6 capsules (600 mg). Strictly follow the instructions of your doctor/pharmacist. For treatment of Wilson's disease or copper/mercury/lead intoxication (adults), take 10 capsules (1,000 mg of the active ingredient) a day in one to several divided doses before meals on an empty stomach. The dosage should be adjusted according to the disease to be treated, age, symptoms, tolerability or response to the medicine in the range of 6-14 capsules (600-1,400 mg) a day. Strictly follow the instructions of your doctor/pharmacist. For copper/mercury/lead intoxication (children), take 20-30 mg of the active ingredient per 1 kg of the body weight a day, before meals on an empty stomach. The dosage should be adjusted according to the disease to be treated, age, symptoms, tolerability or response to the medicine up to 10 capsules (1,000 mg) a day. Strictly follow the instructions of your doctor/pharmacist. Missed dose: Consult with your doctor/pharmacist as soon as possible. DO NOT take double doses to make up for the missed dose. Overdose: If you took too much of the medicine (more than ordered), check with your doctor/pharmacist. Others: Do not stop taking the medicine without the instructions of your doctor. Precautions while using this medicine Side effects of this medicine Common side effects are reported as below. If any of them occurs, check with your doctor/pharmacist: rash, itch, taste abnormality, abdominal pain, etc.In rare cases, symptoms described below may be the sign of side effects indicated in brackets [ ]. If they occur, stop taking your medicine and check with your doctor immediately. gerenal malaise, headache, nasal/gum bleeding [severe blood disorder such as agranulocytosis] swelling, decrease of urine output, breathing difficulty [nephrotic syndrome (membranous nephropathy,etc.)] taste diminished, taste loss, taste differency (not tasting properly, tasting differently from the original) [taste anesthesia] systemic blisters appearing on the skin or on the mucous membrane, blisters may be easily broken, severe itchiness throughout the body [pemphigus like symptoms] symmetric muscle weakness seen in the neck or limbs, swallowing disorder, rash [polymyositis] Other side effects not listed here may occur. Check with your doctor/pharmacist if you have any worrisome symptom.  Storage and other information Keep out the reach of children. Store away from direct sunlight, heat and moisture. Discard the remainder. Do not store them. For further information, ask your doctor/pharmacist. "Kanjamuke Iyakuhin Guide" and Japanese package insert information (for medical professionals) is available on the website of Pharmaceuticals and Medical Devices Agency. Manufacturer's name : Taisho Toyama Pharmaceutical Co., Ltd.  Revised: 03/2010 部份中文青霉素处方资料（仅供参考） 药理作用 本品为青霉素的降解产物，是含有巯基的氨基酸，是铜、汞、锌和铝的有效络合剂，并能促使这些金属从肾脏排泄。用于肝豆状核变性病，用药后可使尿铜排泄增加5～20倍，而改善症状，作用比二巯丙醇强；对汞中毒也有解毒作用，但不及依地酸钙钠和二巯丙磺酸钠，以用N-乙酰-DL青酶胺为好。此外，可用于治疗某些免疫性疾病，如类风湿性关节炎等。 本品是一种含巯基的氨基酸，能断裂二硫键，分解巨球蛋白和类风湿因子，使免疫复合物去聚合，且抑制免疫球蛋白的分泌，从而减少免疫复合物在补体参与下造成的肝细胞损害。 此外，还能抑制脯氨酸酶的羟化作用，抑制肝内前胶原纤维转变为胶原纤维，有防止肝脏纤维化的作用。本品尚有明显的排铜作用。  适应证 用于肝豆状核变性，作用比二巯基丙醇强；对铅、汞中毒亦有解毒作用，但不及依地酸钙钠及二巯丙磺钠；还用于某些免疫性疾病，如类风湿性关节炎等。用于自身免疫性慢性活动性肝炎。 禁忌证 1.对本品过敏者、哺乳者、肾功能不全者禁用。 2.对青霉素类过敏者、粒细胞缺乏症者、再生障碍性贫血者、肌无力、红斑狼疮者禁用。 注意事项 1.慎用：严重皮肤、肝脏、血液病者。 2.用药前应做皮试。 不良反应 1.本品为青霉素的衍生物，与青霉素有交叉过敏反应，可先用小剂量脱敏。 2.不良反应轻微，可长期服用，偶有皮疹、味觉障碍、白细胞和血小板减少、蛋白尿等。偶可引起头痛、咽痛、乏力、恶心、腹痛、腹泻等反应。 3.长期服用，可引起视神经炎(由于抗吡哆醛所致，可用维生素B6治疗)。 4.对肾脏有刺激作用，可出现蛋白尿及肾病综合征。 用法用量 1.治疗肝豆状核变性病： 开始每天250mg，分2次服用，以后每隔数日增加250mg，直至每天2g，分3次服用，1个月后减至每天1g长期服用，症状改善后可间歇给药。 2.铅、汞中毒： 用量为每天1g，分4次服，5～7天为1个疗程。停药2天开始下1个疗程。一般可用1～3个疗程。 3.免疫性疾病： 成人用量为每天1.5～1.8g，分3～4次服用，可用6个月以上。以上均宜空腹服用。口服：自身免疫性慢性活动性肝炎，每天3次，每次0.1～0.3g，6个月为1个疗程；肝豆状核变性，成人每天3次，每天总量20～25mg/kg，症状缓解后改为间歇服药，但需终身服用，剂量大小以每天尿铜排出量达0.2mg为准。儿童每天3次，每天总量20mg/kg。 药物相应作用 本品可加重抗疟药、金制剂、免疫抑制剂、保泰松对造血系统和肾脏的不良反应；与铁剂合用，可使本品吸收减少2/3，故宜在服铁剂前2h口服，以免降低本品疗效；本品是维生素B6拮抗剂，应用本品时应提前给予维生素B6每天30～60mg，防止青霉胺的肝毒性反应；与地高辛同用，会明显降低后者的血浆浓度；与含氢氧化铝或氢氧化镁的复方抗酸药合用，本品的吸收减少，如果必须合用，最好将两药间隔2h；与吡唑类药合用，可使后者的血液系统不良反应增加；与胃肠消化药物合用，能降低青霉胺的吸收，应间隔2h服药；绛矾与本品发生螯合反应，使青霉胺胃肠道吸收减少；与食物同服，可使本品吸收减少50%。 专家点评 目前仍是治疗各型肝豆状核变性(Wilson)病的首选药物。无症状患者亦可长期服用维持量。该药由于对组织驱铜作用迟缓，故不适用于腹型肝豆状核变性等急性型或重症，晚期患者。临床应用本品治疗肝纤维化，但疗效不肯定，不良反应多。该药能抑制该酶的活性，使新分泌出来的胶原不能相互交联，它对肝豆状核变性有较好的疗效，但对其他原因所致肝纤维化无明显疗效，且长期应用副作用较大。 ------------------------------------------------ 产地国家: 日本 原产地英文商品名: Metalcaptase 50mg/cap  100capsules 原产地英文药品名: Magensaftresistente 中文参考商品译名: Metalcaptase胶囊  50毫克/胶囊  100胶囊/盒 中文参考药品译名: 青霉素 生产厂家英文名: Taisho Toyama Pharmaceutical Co., Ltd. ------------------------------------------------ 产地国家: 日本 原产地英文商品名: Metalcaptase 100mg/cap  100capsules 原产地英文药品名: Magensaftresistente 中文参考商品译名: Metalcaptase胶囊  100毫克/胶囊  100胶囊/盒 中文参考药品译名: 青霉素 生产厂家英文名: Taisho Toyama Pharmaceutical Co., Ltd. ------------------------------------------------ 产地国家: 日本 原产地英文商品名: Metalcaptase 200mg/cap  100capsules 原产地英文药品名: Magensaftresistente 中文参考商品译名: Metalcaptase胶囊  200毫克/胶囊  100胶囊/盒 中文参考药品译名: 青霉素 生产厂家英文名: Taisho Toyama Pharmaceutical Co., Ltd.