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Drug Interactions between Campath and Depen Titratabs

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

penicillAMINE alemtuzumab

Applies to: Depen Titratabs (penicillamine) and Campath (alemtuzumab)

MONITOR: The use of alemtuzumab with other immunosuppressive or myelosuppressive agents may increase the risk of infections. Alemtuzumab alone may cause severe and prolonged myelosuppression, lymphopenia, and rarely, fatal bone marrow aplasia/hypoplasia, autoimmune idiopathic thrombocytopenia, and autoimmune hemolytic anemia. Serious, sometimes fatal opportunistic infections have been reported, and the risk may theoretically increase when coadministered with other immunosuppressive therapy. Agents that may be significantly myelo- or immunosuppressive include antineoplastic agents, radiation, zidovudine, linezolid, some antirheumatic agents, high dosages of corticosteroids or adrenocorticotropic agents (greater than 10 mg/day to 1 mg/kg/day, whichever is less, of prednisone or equivalent for more than 2 weeks), and long-term topical or inhaled corticosteroids.

MANAGEMENT: Caution is advised if alemtuzumab must be used in patients who have recently received or are receiving treatment with other immunosuppressive or myelosuppressive drugs, and vice versa. The manufacturer recommends that single doses of alemtuzumab not exceed 30 mg and cumulative weekly doses not exceed 90 mg, since higher dosages are associated with an increased incidence of pancytopenia. Close clinical and laboratory monitoring for the development of severe hematologic adverse effects is recommended both during and after discontinuation of therapy.

References

  1. "Product Information. Campath (alemtuzumab)." Berlex Laboratories PROD (2001):

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Drug and food interactions

Moderate

penicillAMINE food

Applies to: Depen Titratabs (penicillamine)

ADJUST DOSING INTERVAL: Food may interfere with the gastrointestinal absorption of penicillamine. In a study of six healthy volunteers, administration of penicillamine (500 mg) following a standard breakfast reduced the mean peak plasma concentrations of penicillamine by 48% compared to administration in the fasting state.

MANAGEMENT: Penicillamine should be administered on an empty stomach, at least one hour before or two hours after meals, and at least one hour apart from any other drug, food, or milk. This permits maximum absorption and reduces the likelihood of inactivation by metal binding in the gastrointestinal tract.

References

  1. Osman MA, Patel RB, Schuna A, Sundstrom WR, Welling PG "Reduction in oral penicillamine absorption by food, antacid and ferrous sulfate." Clin Pharmacol Ther 33 (1983): 465-70
  2. "Product Information. Cuprimine (penicillamine)." Merck & Co., Inc PROD (2001):

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Moderate

penicillAMINE food

Applies to: Depen Titratabs (penicillamine)

ADJUST DOSING INTERVAL: Oral administration of aluminum, copper, iron, zinc, magnesium, and possibly other minerals such as calcium may decrease the gastrointestinal absorption of penicillamine, and vice versa. The proposed mechanism involves chelation of penicillamine to polyvalent cations, which leads to formation of a nonabsorbable complex. In a study of six healthy volunteers, administration of penicillamine (500 mg) following a single dose of ferrous sulfate (300 mg) or antacid (Maalox Plus 30 mL) reduced the mean peak plasma concentration of penicillamine by 65% and 34%, respectively, compared to administration in the fasting state. In addition to chelation, some investigators suggest that antacids may also reduce penicillamine bioavailability by increasing gastric pH, which favors the oxidation of penicillamine to its poorly absorbed disulfide form. These changes could result in diminished therapeutic effects of penicillamine.

MANAGEMENT: Mineral supplements or other products containing polyvalent cations (e.g., antacids or preparations containing antacids such as didanosine buffered tablets or pediatric oral solution) should be administered at least two hours before or two hours after the penicillamine dose. In addition, pharmacologic response to penicillamine should be monitored more closely whenever these products are added to or withdrawn from therapy, and the penicillamine dosage adjusted as necessary. When penicillamine is coadministered with Suprep Bowel Prep (magnesium/potassium/sodium sulfates), the manufacturer recommends administering penicillamine at least 2 hours before and not less than 6 hours after Suprep Bowel Prep to avoid chelation with magnesium.

References

  1. Osman MA, Patel RB, Schuna A, Sundstrom WR, Welling PG "Reduction in oral penicillamine absorption by food, antacid and ferrous sulfate." Clin Pharmacol Ther 33 (1983): 465-70
  2. Harkness JA, Blake DR "Penicillamine nephropathy and iron." Lancet 2 (1982): 1368-9
  3. Netter P, Bannwarth B, Pere P, Nicolas A "Clinical pharmacokinetics of D-penicillamine." Clin Pharmacokinet 13 (1987): 317-33
  4. Joyce DA "D-penicillamine pharmacokinetics and pharmacodynamics in man." Pharmacol Ther 42 (1989): 405-27
  5. "Product Information. Cuprimine (penicillamine)." Merck & Co., Inc PROD (2001):
  6. Haagsma CJ "Clinically important drug interactions with disease-modifying antirheumatic drugs." Drugs Aging 13 (1998): 281-9
  7. Lyle WH "Penicillamine and iron." Lancet 2 (1976): 420
  8. "Product Information. Suprep Bowel Prep Kit (magnesium/potassium/sodium sulfates)." Braintree Laboratories (2010):
View all 8 references

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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