CUPROS L is used in adults for:
• Rheumatoid arthritis, including juvenile manifestations, when the disease is resistant to other treatments
• Wilson's disease
• Heavy metal poisoning
• Cystinuria

Do not take CUPROS L:
- if you are allergic to penicillamine or any of the other ingredients of this medicine.

Before starting treatment with CUPROS L, blood counts and nervous system tests should be performed to identify special risks. During treatment, the tests should be repeated at regular intervals.
Patients with hypersensitivity tendencies (hay fever, eczema [lichen prurigo], urticaria, dyspnoea attacks [asthma attacks]) require careful monitoring.

Before surgery, treatment with CUPROS L should be discontinued or, if possible, the dose should be reduced at least six weeks before surgery and until the wound is completely healed, as D-penicillamine may affect the cross-links of collagen and elastin tissue (connective tissue). Follow all instructions from your doctor and attend all medical check-ups that your doctor schedules for you.

Pregnancy and breastfeeding:
If you are pregnant or breast-feeding, think you may be pregnant or are planning to become pregnant, ask your doctor or pharmacist before taking this medicine.
If CUPROS L is used during pregnancy in large amounts, it may cause fetal harm.
Therefore, women of childbearing potential should use contraceptive methods during treatment. CUPROS L should not be used for the treatment of rheumatoid arthritis during pregnancy. For other conditions, medical treatment with CUPROS L should only be continued
if no other therapy with a better benefit/risk ratio is available.
You should not breastfeed during medical treatment with CUPROS L.

Driving and using machines:
Do not drive or use machines if you feel dizzy, tired, sleepy, have vertigo or blurred vision after taking CUPROS L.

Always take CUPROS L exactly as your doctor has told you. Ask your doctor or pharmacist if you have any further questions.

The total daily dose should be divided into 2-3 doses per day.
The recommended dose is:
Rheumatoid arthritis:
It is recommended to administer small doses at the beginning of treatment, gradually increasing them later.
Adults: The dose in adults should not normally exceed 125-250 mg per day during the first four weeks of treatment, which should be increased progressively (every 4-8 weeks) until improvement occurs. The usual dose ranges from 500-700 mg/day, and can even reach 1,000 mg/day. The lowest effective dose should always be used.
Children: It is recommended to administer in the form of 50 mg capsules, starting with 1 or 2 capsules per day and then gradually increasing depending on the child's weight up to 10-20 mg/kg/day.
As with adults, stick to the minimum effective dose.

Wilson's disease:
In the case of Wilson's disease, the dose must be adjusted on a case-by-case basis, taking as parameters the amount of copper excreted in the urine.
As a guideline, doses of 2,000–1,000 mg/day are recommended for adults and approximately 20 mg/kg/day for children. Due to the effects of penicillamine on collagen, it is recommended to discontinue treatment or reduce the dose to 250 mg per day if the patient is to undergo surgery. Treatment should only be resumed after complete wound healing.

Heavy metal poisoning:
In case of lead or other heavy metal poisoning, doses of 500-1,000 mg/day are recommended for adults. The daily dose should not exceed 40 mg of penicillamine per kg of body weight when a longer period of treatment is necessary.

Cystinuria:
In case of cystinuria, the dose should be adjusted individually, taking as parameters the amount of cystine excreted in the urine. Patients with cystinuria take 1,200 - 1,800 mg of penicillamine 4 times a day, depending on the amount of cystine excreted.

Route and method of administration:
The capsules should be swallowed whole, with plenty of water (this is especially true for the treatment of cystinuria) and on an empty stomach, i.e. one hour before or two hours after a meal.

Duration of treatment:
Your doctor will decide the duration of treatment depending on the progression of the disease.

- The active substance is D-penicillamine. Each capsule contains 250 mg of D-penicillamine.
- The other ingredients are: magnesium stearate.

Warning:
Read all of this leaflet carefully before you start using this medicine because it contains important information for you.

50 capsules