Drug General Information (ID: DDIWNZAPR6)
Drug Name			Penicillamine		Drug Info		Didanosine		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antidotes				Anti-Hiv Agents
Structure

Mechanism of Penicillamine-Didanosine Interaction (Severity Level: Moderate)
Complex formation Click to Show/Hide Mechanism Graph
Drug Name		Penicillamine				Didanosine
Mechanism		Binds to polyvalent cations				Polyvalent cations
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 Didanosine due to formation of complexes caused by Penicillamine

Recommended Action
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pharmacologic response to penicillamine should be monitored more closely whenever these products are added to or withdrawn from therapy, and the penicillamine dosage adjusted as necessary.

References
1	Haagsma CJ "Clinically important drug interactions with disease-modifying antirheumatic drugs." Drugs Aging 13 (1998): 281-9. [PMID: 9805209]
2	Harkness JA, Blake DR "Penicillamine nephropathy and iron." Lancet 2 (1982): 1368-9. [PMID: 6129465]
3	Joyce DA "D-penicillamine pharmacokinetics and pharmacodynamics in man." Pharmacol Ther 42 (1989): 405-27. [PMID: 2672052]
4	Lyle WH "Penicillamine and iron." Lancet 2 (1976): 420. [PMID: 73880]
5	Netter P, Bannwarth B, Pere P, Nicolas A "Clinical pharmacokinetics of D-penicillamine." Clin Pharmacokinet 13 (1987): 317-33. [PMID: 3319347]
6	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. [PMID: 6831825]
7	Product Information. Cuprimine (penicillamine). Merck & Co, Inc, West Point, PA.
8	Product Information. Suprep Bowel Prep Kit (magnesium/potassium/sodium sulfates). Braintree Laboratories, Braintree, MA.