Pharmacokinetic interaction study with ramipril and digoxin in healthy volunteers

Doering, W.; Maass, L.; Irmisch, R; König, E

doi:10.1016/0002-9149(87)90055-5

Cited by 18 publications

(6 citation statements)

References 4 publications

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“…Nevertheless, a single oral dose of 20 mg of Lisinopril had no significant effect on the pharmacokinetics of a single 0.25 mg dose of digoxin in 12 healthy young men, even though a non-significant tendency for increased renal clearance of digoxin was noted (18). Daily dose of 5 mg ramipril for 14 days caused no change in mean serum digoxin level in 12 healthy volunteers (19).…”

Section: Discussionmentioning

confidence: 93%

Comparative Effects of Losartan and Enalapril on Serum Digoxin Levels in Patients With Congestive Heart Failure

et al. 2004

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Section: Discussionmentioning

confidence: 93%

Comparative Effects of Losartan and Enalapril on Serum Digoxin Levels in Patients With Congestive Heart Failure

et al. 2004

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“…For example, captopril increases serum digoxin by about 25% and the mechanism involved appeared to be a reduction of renal clearance of digoxin [11]. In contrast, neither ramipril nor lisinopril altered digoxin levels in volunteers [12,13].…”

Section: Discussionmentioning

confidence: 99%

Effect of multiple doses of losartan on the pharmacokinetics of single doses of digoxin in healthy volunteers.

Smet¹,

Schoors²,

Meyer³

et al. 1995

Brit J Clinical Pharma

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1 Losartan (DuP 753, MK-954) is a novel, potent and highly selective AT1angiotensin II receptor antagonist. The effect of multiple oral doses of losartan on digoxin pharmacokinetics was evaluated in healthy male subjects. 2 In a double-blind and randomized fashion, subjects received 50 mg losartan or placebo once daily for 15 days in each period. At least 7 days elapsed between the two treatment periods. On days 4 and 11 of each period, subjects also received a single 0.5 mg dose of digoxin intravenously and orally respectively. 3 Eleven of 13 subjects completed the study. Side effects were mild and transient (12 out of 13 subjects reported at least one adverse experience). During the study, no laboratory abnormalities were noted. 4 Multiple oral doses of losartan (50 mg

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“…In healthy volunteers, Doering et al (1987) reported the effects of ramipril on serum digoxin concentration after multiple administration. All of 12 volunteers were receiving steady-state digoxin medication (0.5mg daily) plus ramipril (5mg daily) for 14 days.…”

Section: Digoxinmentioning

confidence: 99%

Pharmacokinetic Drug Interactions with ACE Inhibitors

Shionoiri

1993

Clinical Pharmacokinetics

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Angiotensin converting enzyme (ACE) inhibitors which have active moieties excreted mainly in urine require adjustment of either the dose or the interval between doses in patients with moderate to severe renal dysfunction or severe congestive heart failure. Those agents such as temocapril (CS 622) and fosinopril, excreted both in urine and bile, may not require such adjustment. Renal clearance of ACE inhibitors may be reduced and some accumulation may occur in elderly patients with mild renal dysfunction or congestive heart failure. The bioavailability of ACE inhibitors is reduced by concomitant food or antacids which may slow gastric emptying and raise gastric pH. Pharmacokinetic interactions with ACE inhibitors are unlikely in patients receiving thiazide or loop diuretics. When ACE inhibitors are given hyperkalaemia may occur in patients with renal insufficiency, those taking potassium supplements or potassium-sparing diuretics, and in diabetic patients with mild renal impairment. While no pharmacokinetic interaction precludes use of this combination, the pharmacokinetics of some ACE inhibitors are subject to greater variability when patients also receive beta-blockers. Calcium antagonists and ACE inhibitors have additive anti-hypertensive effects and pharmacokinetic interactions between these agents are unlikely. One report exists of a significant effect of coadministered hydralazine on the pharmacokinetics and urinary excretion of lisinopril. Data on interactions between ACE inhibitors and digitalis are contradictory. There is no evidence that the concomitant use of ACE inhibitors and digoxin is associated with an increased risk of digitalis toxicity. ACE inhibitors are mainly excreted by glomerular filtration and renal tubular secretion. Possible interactions between ACE inhibitors and probenecid have been noted, with renal and total body clearance of ACE inhibitors being potentially reduced in the presence of probenecid. Probenecid pretreatment may enhance the pharmacodynamic response of ACE inhibitors. Few but contradictory data exist on the effects of H2-blockers on ACE inhibitor pharmacokinetics and little information is available on interactions between ACE inhibitors and hypoglycaemic drugs. Some case reports link ACE inhibitors with the induction of lithium toxicity. Coadministration of lithium should be undertaken with caution, and frequent monitoring of lithium concentrations is recommended with all ACE inhibitors. Nonsteroidal anti-inflammatory drugs (NSAIDs) may attenuate the haemodynamic actions of ACE inhibitors. NSAIDs reduce renal excretion of ACE inhibitors, with a corresponding increase in circulating drug concentrations. There is little information available on the pharmacokinetic interaction with ACE inhibitors and cyclosporin, but caution should be employed when they are used together.(ABSTRACT TRUNCATED AT 400 WORDS)

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Pharmacokinetic interaction study with ramipril and digoxin in healthy volunteers

Cited by 18 publications

References 4 publications

Comparative Effects of Losartan and Enalapril on Serum Digoxin Levels in Patients With Congestive Heart Failure

Comparative Effects of Losartan and Enalapril on Serum Digoxin Levels in Patients With Congestive Heart Failure

Effect of multiple doses of losartan on the pharmacokinetics of single doses of digoxin in healthy volunteers.

Pharmacokinetic Drug Interactions with ACE Inhibitors

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