Penicillamine Levodopa

Allopurinol, aspirin, carbamazepine, chlorpropamide, clomipramine, clozapine, colchicine, desipramine, gold salts, imipramine, levodopa, penicillamine, phenothiazines, phenytoin, propylthiouracil, and sulfonylureas... 

The harm may be life-destroying, as in the rare sudden death following an iajection of penicillin, rightly regarded as one of the safest of antibiotics, or the destruction of the quality of life that occasionally attends the use of drugs that are effective in rheumatoid arthritis (adrenocortical steroids, penicillamine), and Parkinson s disease (levodopa). 

Interactions. Iron chelates in the gut with tetracyclines, penicillamine, methyldopa, levodopa, carbidopa, ciprofloxacin, norfloxacin and ofloxacin it also forms stable complexes with thyroxine, captopril and biphosphonates. These interactions can be clinically important. Ingestion should be separated by 3 hours. 

It should be noted, however, that despite the general preference for the marketing of synthetic chiral therapeutic agents in racemic form, a few synthetic chiral drugs were introduced in a unichiral form. Such exceptions included the above-mentioned levodopa and also n-penicillamine 31 [78], (-)-timolol 32 [87], methyl-dopa 33 [88], etc, and it is clear that in most such cases the choice of developing a unichiral form was dictated by overt serious toxicity present predominantly in the ofher enantiomer. 

Penicillamine can raise plasma levodopa levels in a few patients. This may improve the control of the parkinsonism but the adverse effects of levodopa may also be increased. 

This limited evidence suggests that the concurrent use of levodopa and penicillamine need not be avoided, and in some patients parkinsonian symptoms may be improved. However, if both drugs are given, monitor the effects as an increase in the adverse effects of levodopa is also possible. 

MizutaE, Kuno S. Effect of D-penicillamine on pharmacokinetics of levodopa in Parkinson s disease. Clin Neuropharmacol( 993 ) 16, 448-50. 

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