Digoxin Plasma Concentrations and Nifedipine

Belz, G. G.; Aust, Peter; Munkes, R.

doi:10.1016/s0140-6736(81)92727-6

Cited by 87 publications

(19 citation statements)

References 7 publications

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“…However, no concentration-response relationship of the digoxin effect before and during nifedipine therapy was reported and the observed improvement in cardiac function can be explained by alterations in pre-and afterload (Buch et al, , 1983. An elevation in plasma digoxin level has been demonstrated when nifedipine was added to digoxin tablet ingestion in healthy subjects (Beltz et al, 1981). We were not able to confirm this finding.…”

Section: Methodsmentioning

confidence: 69%

Influence of atenolol and nifedipine on digoxin‐induced inotropism in humans.

Pb¹,

Buch²,

Rasmussen³

et al. 1984

Brit J Clinical Pharma

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1 Short term effect of digoxin on left ventricular performance was studied in six healthy volunteers before and during atenolol or nifedipine administration. Left ventricular function was evaluated by systolic time intervals and echocardiography. 2 No changes in left ventricular end diastolic or systolic dimensions occurred throughout the study, indicating unchanged ventricular pre-and afterload. Thus, changes in the systolic time intervals must be attributed to changes in cardiac contractility. Changes in the pre-ejection period index (PEPI) obtained from the systolic time intervals were used as a measure of digoxin-induced inotropism. 3 A concentration-response relationship between plasma digoxin level and changes in PEPI was revealed when digoxin was given alone. Atenolol did not influence the digoxin-induced inotropism at a given serum digoxin level. During nifedipine administration no inotropic effect of digoxin could be demonstrated. 4 Thus, it is concluded that nifedipine attenuates digoxin-induced inotropism, while atenolol seems without this effect. 5 These results are in accordance with previous experiments and reflect the different pharmacological sites of action of P-adrenoceptor antagonists and calcium channel blocking agents. 6 Plasma digoxin concentration, renal digoxin clearance and creatinine clearance did not change during atenolol or nifedipine.

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Section: Methodsmentioning

confidence: 69%

Influence of atenolol and nifedipine on digoxin‐induced inotropism in humans.

Pb¹,

Buch²,

Rasmussen³

et al. 1984

Brit J Clinical Pharma

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“…There have also been a few reports on the interactions between sustained-release nifedipine and other cardiovascular agents (13)(14)(15)(16)(17). It was reported that nifedipine increased the plasma concentration of digoxin by 45% in 9 of 12 volunteers by an unknown mechanism (13), whereas others reported no significant changes in the serum digoxin levels by the concurrent use of nifedipine (14,15). One possible mechanism for the increase in the serum digoxin levels is an inhibition of the clearance of digoxin as suggested for the interaction between digoxin and verapamil (18).…”

Section: Discussionmentioning

confidence: 99%

Influence of Cisapride on the Pharmacokinetics and Antihypertensive Effect of Sustained-Release Nifedipine.

et al. 1996

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To investigate the clinical significance of interactions between cisapride and sustained-release nifedipine, we comparedthe plasma nifedipine concentration and blood pressure after administration of nifedipine alone (20 mg) with those obtained after administration of nifedipine with cisapride (2.5 mg) in 20 patients with hypertension. The plasma nifedipine level was not altered by cisapride at one hour after administration, but was significantly increased at two (p<0.01), three (p<0.01), and four (p<0.05) hours when compared with the level measured after nifedipine alone. Cisapride significantly decreased the mean blood pressure at three hours (p<0.05) after administration ofnifedipine. The acetaminophen method was used to determine gastric emptying time. The plasma concentration of acetaminophenat 45 minutes after administration was significantly increased by cisapride, suggesting that enhanced gastrointestinal motility might be the basis for the increase in the plasma nifedipine concentration. These results suggest that enhancement of the antihypertensive effect ofnifedipine can occur when the drug is prescribed with cisapride, and that caution is needed whenusing such a combination therapy. (Internal Medicine 35: 941-945, 1996)

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“…Several drugs, notably quinidinc [Hager et al, 1979] and verapamil [Belz et al, 1981;Pedersen et al, 1981], have been reported to elevate plasma digoxin levels. More recently a similar action, perhaps through a different mechanism(s), has been ascribed to nifedi pine [Belz et al, 1981] and diltiazem [Rameis et al, 1984].…”

Section: Discussionmentioning

confidence: 99%

Comparative Effects of Verapamil, Diltiazem and Felodipine during Experimental Digitalis-Induced Arrhythmias

Lr¹,

Rm²,

Sl³

et al. 1987

Pharmacology

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We compared the abilities of three different calcium (Ca²⁺) entry blockers, verapamil, diltiazem and felodipine to abolish ouabain-induced ventricular ectopy (100 × ectopic/total beats, VE) in anesthetized, closed-chest dogs. Ventricular tachycardia (VT) was produced in anesthetized, bilaterally vagotomized, closed-chest dogs by an average dose of 65 ± 19 μg/kg ouabain. 30 min after establishing VT, either verapamil (25–50 μg/kg + 5–10 μg/kg/min), diltiazem (50–100 μg/kg + 20–50 μg/kg/min), felodipine (3 μg/kg + 0.3 μg/kg/min) or saline was administered for another 30 min. Verapamil, at the higher dose utilized, practically abolished ouabain-induced VT (97 ± 3 to 8 ± 19% VE); diltiazem was moderately effective (96 ± 4 to 50 ± 8% ectopy) at 100 μg/kg, and felodipine exerted no antiarrhythmic effects in this model. All three Ca²⁺ entry blockers lowered mean aortic pressure, felodipine lowering this parameter most prominently. Thus, these structurally and electrophysiologically dissimilar Ca²⁺ entry blockers differed in their abilities to abolish the digitalis glycoside-induced arrhythmias in vivo. The superiority of verapamil may be related to its multiple, additional electrophysiologic effects.

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Digoxin Plasma Concentrations and Nifedipine

Cited by 87 publications

References 7 publications

Influence of atenolol and nifedipine on digoxin‐induced inotropism in humans.

Influence of atenolol and nifedipine on digoxin‐induced inotropism in humans.

Influence of Cisapride on the Pharmacokinetics and Antihypertensive Effect of Sustained-Release Nifedipine.

Comparative Effects of Verapamil, Diltiazem and Felodipine during Experimental Digitalis-Induced Arrhythmias

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