PENICILLAMINE

Adult: by mouth, initially 125–250 mg once daily before food for 1 month, then increased by the same amounts at intervals of at least 4 weeks to a usual maintenance dose of 500–750 mg daily in divided doses (max 1500 mg daily).
If remission occurs after 6 months, attempt dose reduction by 125–250 mg every 12 weeks

Child 8–12 years: initially 2.5–5 mg/kg daily, gradually increased at least every 4 weeks to a usual maintenance dose of 15–20 mg/kg daily over 3–6 months

Elderly: initially 125 mg daily before food for 1 month, then increased with the same amounts at least every 4 weeks (max 1 g daily)

Adult: 1–2 g daily in divided doses before food, until urinary lead is stabilized at less than 500 micrograms/day

Child: 20 mg/kg/day in divided doses

Adult and child over 12 years: 1.5–2 g daily in divided doses before food (max 2 g daily for 1 year), thereafter 0.75–1 g daily

Child 1 month–12 years: 2.5 mg/kg every 12 hours before food, increased at 1–2 week intervals to 10 mg/kg every 12 hours

Elderly: 20 mg/kg daily in divided doses adjusted according to response

Adult and child over 12 years: therapeutic, 1000–3000 mg daily in divided doses before food, adjusted to maintain urinary cystine below 200 mg/l

Prophylactic (maintain urinary cystine below 300 mg/l) → 500 mg–1000 mg at bedtime

Child 1 month–12 years: prophylaxis, 20–30 mg/kg/day in 2–3 divided doses adjusted to keep urinary cystine below 200 mg/l

Elderly: lowest dose to keep urinary cystine < 200 mg/l