Drug General Information (ID: DDIW9TSH3Z)
Drug Name			Tolevamer		Drug Info		Calcium carbonate		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Potassium-Binding Resin				Antacids/Minerals And Electrolytes
Structure

Mechanism of Tolevamer-Calcium carbonate Interaction (Severity Level: Major)
Complex formation Click to Show/Hide Mechanism Graph
Drug Name		Tolevamer				Calcium carbonate
Mechanism		Cation exchange resin/polymer				Binds to cation exchange resin/polymer
Key Mechanism Factor 1
		Factor Name		Chelation
		Factor Description		Chelation is a direct drug interaction that usually involves the formation of dimers or trimers, resulting in larger complexes and poorer absorption.
Mechanism Description		Decreased absorption of Tolevamer due to formation of complexes caused by Calcium carbonate

Recommended Action
Management		Nonabsorbable calcium, magnesium, or aluminum preparations such as antacids or laxatives should not be used in patients receiving oral cation-exchange resins. alternatively, the interaction may be avoided by administering the resin as an enema.

References
1	Product Information. Resonium Calcium (calcium polystyrene sulfonate). Sanofi-Synthelabo Canada Inc, Markham, ON.
2	Ziessman HA "Alkalosis and seizure due to a cation-exchange resin and magnesium hydroxide." South Med J 69 (1976): 497-9.[PMID: 817399]
3	Madias NE, Levey AS "Metabolic alkalosis due to absorption of "nonabsorbable" antacids." Am J Med 74 (1983): 155-8.[PMID: 6849324]