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Penicillamine protocol (based on Jaffe) 1 Penicillamine protocol (based on Jaffe) for determining toxic and nutritional mineral status by provocation into the urine Purpose: Determine the body's burden of mobilizable, potentially toxic minerals. Nutritional divalent mineral status may also be assessed. Method: A short (3-day) course of d-penicillamine [Cupramine™, D-Pen™, dimethylcysteine, mercaptovaline] or Acetyl-d-penicillamine is prescribed. Specimen for analysis: Collect a 24º urine on the 2 nd day. Protocol: • Take 500 mg. (2 capsules of 250 mg. each) d-penicillamine or N-Acetyl-d-penicillamine with each meal and before bed for just three (3) days. This is a total of 2 grams each day for three (3) days for a typical 70 Kgm. adult. This is based on 30 mg./Kgm. body weight. If weight is under 100 pounds or over 300 pounds, calculation of dose is recommended. * For example, a 100-pound adult weighs 45.5 Kgms. A daily dose of 1,590 mg. (~1,500 mg.) is recommended. This would most easily be achieved by giving two (2) x 250 mg. capsules with breakfast, dinner, and at bedtime [two (2) capsules TID]. * By comparison, a 350-pound person weighs 160 Kgm. At 30 mg./Kgm., this calculates to a daily dose of 4,800 mg. (~4,750 mg.). This means taking five (5) x 250 mg. capsules with each of three (3) meals plus four (4) x 250 mg. capsules at bedtime. • Starting on the morning of the second day, collect in a heavy metal-free container (usually provided by the doctor or the laboratory) all urine output for the next day (a full 24-hour cycle). It is quite important to collect ALL the urine. • If a urine sample is missed, the collection is incomplete. Start over with a new provocation one week later. Urine collected in an incomplete sample may be poured out and the same collection container reused. Take the entire urine collection to the laboratory as soon as possible after completion. The total volume is an important part of the information to be sent to the analytic lab. It is desirable, although not necessary, to keep the urine refrigerated during the collection period. Note: A third-day collection can not be compared with the standardized second-day collection results. Because of short-term effects on other minerals, this specimen should not be used for calcium or other mineral balance studies. The specimen may also be used to check kidney function and to analyze for most hormones, neurotransmitter metabolites, etc. This short course of d-penicillamine avoids the rare but important side effects of longer- term therapeutic doses of the drug as discussed in the Physicians Desk Reference (PDR). Of course, if you note any adverse response, discontinue taking the medication until otherwise instructed by your health professional. Interpretation and substantiation of d-penicillamine protocol: • Each laboratory has an applicable reference range for each mineral assayed. Elevation above the range reported by that laboratory is indicative of increased tissue stores of that heavy metal. Tissue status of nutritional minerals may also be assessed in this way. Typical d- penicillamine provocation reference ranges are included in the table at the end of this document. HEALTH STUDIES COLLEGIUM 109 Carpenter Drive, Suite 100 • Sterling, VA 20164 • Phone: 800.328.7372 • Fax: 703.450.2997

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