Effect of cholestyramine on digoxin absorption and excretion in man

Hall, William H.; Shappell, Stephen D.; Doherty, James E.

doi:10.1016/s0002-9149(77)80193-8

Cited by 31 publications

(6 citation statements)

References 6 publications

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“…Thus, a problem may be encountered, particularly if both drugs are ingested simultaneously or taken close together. It is wise to administer digoxin at least 2 h before colestipol or cho lestyramine resin [78,79).…”

Section: Hypolipidemic Drugsmentioning

confidence: 99%

Clinical Use of Digitalis Glycosides

Doherty¹

1985

Cardiology

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Digitalis glycosides continue to place high on the list of prescribed drugs. Digoxin is 8th on prescriptions written in the United States in 1980, digitoxin 16th, and digitalis leaf 23rd. There is little doubt that most physicians continue to believe these drugs are useful. The application of more definite indications, smaller doses, and the recognition of the role of pharmacokinetics and drug interactions make use of the glycosides more challenging than ever before in 1985.

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Section: Hypolipidemic Drugsmentioning

confidence: 99%

Clinical Use of Digitalis Glycosides

Doherty¹

1985

Cardiology

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“…d) When other medications administered Simultaneously may interfere with the absorption of digoxin. Several medications, including antacids (Brown and Juhl, 1976), cholestyramine, although perhaps not significantly (Hall et al, 1977) and neomycin (Lindenbaum et aI., 1976), have been shown to interfere with the absorption of cardiac glycosides. If a patient is taking digoxin in combination with one of these drugs, the serum digoxin concentration value will be important for judging whether or not the digoxin is being absorbed.…”

Section: Indicationsfor the Use Of Serum Digoxin Concentrationsmentioning

confidence: 99%

Interpretation of the Serum Digoxin Concentration

Weintraub

1977

Clinical Pharmacokinetics

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Significant problems exist in the interpretation of serum digoxin concentration data. Failure to distinguish between results that do not require precise clinical correlation (proof of absorption, presence of drug, etc) and those which depend upon clinical correlation for their meaning ('toxicity' or 'effectiveness') can result in interpretive errors. Problems relating to the source of the serum digoxin concentration can also confound interpretation. Such difficulty may be controllable (obtaining the sample at the proper time, haemolysis, etc) or related to the laboratory technique (cross-reactivity with digoxin metabolites or other medications, technical errors, or lack of precision). Variation within the same patient over time or between patients related to disease (alterations in electrolytes, adrenergic or parasympathomimetic tone, or other medications) may prevent the direct attribution of an observed phenomenon to a particular digoxin concentration. Techniques for determining the effect of digoxin do exist and can be used to gather data for clinical correlations. Ways of improving the interpretaion of serum digoxin concentrations also exist and should be used to improve their value in patient management. The serum digoxin concentration seems to have an important future role. However, we need to know how better to interpret and exploit serum digoxin concentration data.

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“…However, many of the published data concerning the interactions are apparently inconsistent. The resins may affect the absorption of digitalis-glycosides (van Bever et al, 1976;Hall et al, 1977;Kuhlmann, 1984) and of some acidic (Hunninghake & Pollack, 1977) and basic drugs (Hibbard et al, 1984). However, there are no data available in the literature on the possible effects of resins on the absorption of frusemide and carbamazepine, both important drugs.…”

Section: Introductionmentioning

confidence: 99%

Effects of resins and activated charcoal on the absorption of digoxin, carbamazepine and frusemide.

Neuvonen

Kivistö

Hirvisalo

1988

Brit J Clinical Pharma

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1. The interference of resins and activated charcoal with the absorption of digoxin, carbamazepine and frusemide was studied. 2. In a cross‐over study consisting of four phases, single doses of colestipol hydrochloride (10 g), cholestyramine (8 g), activated charcoal (8 g) or water only were given to six healthy volunteers immediately after the simultaneous ingestion of digoxin (0.25 mg), carbamazepine (400 mg) and frusemide (40 mg). Plasma and urine concentrations of the test drugs and the urine volumes were determined up to 72 h. 3. The absorption of digoxin was not reduced by colestipol, moderately (30‐40%, P less than 0.05) reduced by cholestyramine and greatly (96%) by charcoal. 4. The absorption of carbamazepine was not decreased by cholestyramine, slightly (10%) by colestipol and greatly (90%) by activated charcoal. 5. The absorption and the diuretic effect of frusemide were significantly diminished by all agents. The bioavailability was reduced by colestipol 80%, by cholestyramine 95% and by activated charcoal 99.5%. 6. The interference with the gastrointestinal absorption of most of the basic drugs by colestipol and cholestyramine seems to be minimal. On the other hand, the resins may seriously impair the absorption of certain acidic drugs, for example frusemide.

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Effect of cholestyramine on digoxin absorption and excretion in man

Cited by 31 publications

References 6 publications

Clinical Use of Digitalis Glycosides

Clinical Use of Digitalis Glycosides

Interpretation of the Serum Digoxin Concentration

Effects of resins and activated charcoal on the absorption of digoxin, carbamazepine and frusemide.

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