Propantheline and Cholestyramine Alter Digoxin Bioavailability

doi:10.1007/bf03312413

DIGOXIN BIOAVAILABILITY

The Medical Journal of Australia ◽

10.5694/j.1326-5377.1973.tb129816.x ◽

1973 ◽

Vol 2 (20) ◽

pp. 913-914

Keyword(s):

Digoxin Bioavailability

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ALTERED DIGOXIN BIOAVAILABILITY

The Lancet ◽

10.1016/s0140-6736(74)92459-3 ◽

1974 ◽

Vol 303 (7849) ◽

pp. 167-168 ◽

Cited By ~ 1

Author(s):

C.D Michalopoulos ◽

C.V Koutoulidis

Keyword(s):

Digoxin Bioavailability

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Re-examining digoxin bioavailability after half a century: Time for changes in the bioavailability concepts

Pharmaceutical Research ◽

10.1007/s11095-021-03121-w ◽

2021 ◽

Author(s):

Athanasios A. Tsekouras ◽

Panos Macheras

Keyword(s):

Digoxin Bioavailability

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Effect of cisapride and metoclopramide on digoxin bioavailability

European Journal of Drug Metabolism and Pharmacokinetics ◽

10.1007/bf03189108 ◽

1986 ◽

Vol 11 (4) ◽

pp. 249-250 ◽

Cited By ~ 19

Author(s):

W. Kirch ◽

H. D. Janisch ◽

S. R. Santos ◽

U. Duhrsen ◽

P. Dylewicz ◽

...

Keyword(s):

Digoxin Bioavailability

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Digoxin Toxicity Secondary to Clarithromycin Therapy

Annals of Pharmacotherapy ◽

10.1177/106002809703100711 ◽

1997 ◽

Vol 31 (7-8) ◽

pp. 864-866 ◽

Cited By ~ 25

Author(s):

James J. Nawarskas ◽

David M. McCarthy ◽

Sarah A. Spinier

Keyword(s):

Digoxin Concentration ◽

Serum Digoxin Concentration ◽

Digoxin Toxicity ◽

Case Summary ◽

Serum Digoxin ◽

St Segment ◽

Digoxin Bioavailability ◽

Electrocardiogram Ecg ◽

Ecg Abnormalities ◽

Digoxin Therapy

OBJECTIVE: To report a case of digoxin toxicity thought to be secondary to clarithromycin therapy. CASE SUMMARY: A 78-year-old white woman with congestive heart failure taking digoxin 0.25 mg po qd presented to our hospital with nausea, vomiting, and diarrhea. She had taken clarithromycin 500 mg po bid for 3 days, and a serum digoxin concentration obtained the day of admission was 4.4 μg/L. An electrocardiogram (ECG) done on admission revealed ST segment changes consistent with digoxin effect and later asymptomatic, nonsustained ventricular tachycardia (NSVT). Clarithromycin was discontinued and digoxin was withheld at admission, resulting in the resolution of symptoms, ECG abnormalities, and NSVT on day 3 of hospitalization. On day 5 her serum digoxin concentration was 1.5 μg/L and digoxin therapy was reinstituted at a dose of 0.125 mg/d po. DISCUSSION: This is the fourth published case implicating clarithromycin as the cause of digoxin toxicity. This interaction is most likely due to clarithromycin eradication of digoxinmetabolizing gut flora, thereby increasing digoxin bioavailability. CONCLUSIONS: Approximately 10% of patients are thought to be extensive presystemic metabolizers of digoxin and may therefore be most susceptible to a drug interaction with clarithromycin. Serum digoxin concentrations in such patients should be monitored closely during clarithromycin therapy.

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