Interactions between gold-sodium-thiomalate(gold sodium thiomalate) and Depen (penicillamine)
gold sodium thiomalate and penicillamine (Moderate Drug-Drug)
GENERALLY AVOID: The concomitant use of penicillamine and gold salts may potentiate the risk of serious hematologic, dermatologic and renal adverse reactions due to overlapping toxicity profiles of these drugs. With respect to sequential use, prior development of toxicity with gold salts may be associated with increased risk of toxicity, though not necessarily of the same type, during subsequent therapy with penicillamine. Some studies have reported a higher frequency of penicillamine adverse reactions in patients who had previously experienced major toxic reactions with gold compounds, particularly proteinuria and bone marrow depression. One group of investigators found that to be true when penicillamine was prescribed less than 6 months after an adverse reaction to gold, and a shorter time interval between treatments was associated with more similar toxic effects to both drugs. Based on these findings, they suggested that the mechanism might involve mobilization of gold stores from various tissues via chelation with penicillamine. Another investigator suggested a genetic predisposition, while others have not found a predictable pattern of penicillamine toxicity based on previous gold use or intolerance or interval between treatments.
MANAGEMENT: Penicillamine and gold therapy should not be administered concurrently. Penicillamine may be prescribed following discontinuation of gold therapy, although some have suggested waiting a period of at least six months between treatments. Patients should be monitored closely and advised to notify their physician if they experience signs and symptoms of penicillamine toxicity such as fever, chills, sore throat, unusual bruising or bleeding, hematuria, coughing, wheezing, unexplained shortness of breath, muscle weakness, or double vision.
