Chelators
Heavy Metal Antagonists/Chelators/Nutrient Depletion:
CarnitineCarnitine: Based on clinical studies, penicillin derivatives (pivaloyloximethyl-esterified, pivampicillin, pivmecillinam) may decrease serum carnitine concentrations, elevate excretion of acyl-carnitine, and reduce muscle carnitine concentrations (2570185, 7551831). No clinical signs of carnitine deficiency were reported. Human study indicates that pivampicillin treatment may also reduce levels of total carnitine, free carnitine, and acylcarnitines (3675603).
CopperCopper: Trientine (Syprine?, Trien?) chelates copper and may be used in the management of Wilson's disease. Penicillamine (Cuprimine?, Depen?) may dramatically increase the urinary excretion of copper, and individuals taking penicillamine for reasons other than copper overload may have an increased requirement for copper. Based on a study of patients with primary biliary cirrhosis, therapy with D-penicillamine and a low-copper diet may sustain increased urinary copper excretion for up to one year (870369). Another human study showed an increase in urinary copper excretion after one year of penicillamine use (3705660).
IronIron: According to secondary sources, desferrioxamine is an iron-chelating drug that lowers iron levels. Secondary sources also indicate that oral iron supplements may reduce absorption of penicillamine (Cuprimine?, Depen?) by 30% to 70%, probably due to chelate formation. Secondary sources cite that the efficacy of penicillamine is reduced in Wilson's disease; the clinical significance in people with rheumatoid arthritis (RA) is currently lacking. Patients may be advised to take penicillamine at least two hours before or after iron-containing supplements.
Magnesium:Magnesium: Based on human evidence, penicillamine may not affect the excretion of magnesium (3705660).
Vitamin B6/pyridoxineVitamin B6/pyridoxine: According to secondary sources, penicillamine (Cuprimine?, Depen?) may increase pyridoxine requirements.
ZincZinc: Based on human evidence, deferoxamine (Desferal?) may increase urinary zinc elimination (10535525, 8217542). Based on a review and human study, penicillamine (Cuprimine?) chelates zinc and may reduce the effects of supplemental zinc (18473004), and may moderately increase the urinary excretion of zinc (3705660).