Pharmacokinetics of digoxin alone and in the presence of indomethacin therapy.

Finch, MB; Johnston, G D; Kelly, J.G.; McDevitt, DG

doi:10.1111/j.1365-2125.1984.tb02353.x

Cited by 15 publications

(7 citation statements)

References 10 publications

(10 reference statements)

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“…Some studies in healthy volunteers have failed to demonstrate a significant interaction between digoxin and aspirin (Fenster et al 1982a) or between digoxin and indomethacin (Finch et al 1984), but other studies report a 30% rise in serum digoxin concentration attributable to aspirin (lsbary et al 1982) and a 25 to 55% increase in serum digoxin concentration following the addition of indomethacin (Isbary et al 1982;Koren 1985). It has been suggested that the potential for interaction between indomethacin and digoxin may be greater in patients with reduced renal function (Marcus 1985).…”

Section: Non-steroidal Anti-inflammatory Drugsmentioning

confidence: 95%

Pharmacokinetic Interactions with Digoxin

Rodin

Johnson

1988

Clinical Pharmacokinetics

100

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Numerous pharmacological agents have been shown to produce clinically significant pharmacokinetic interactions with digoxin. Drugs which reduce digoxin absorption include the antacids aluminium hydroxide, magnesium hydroxide and magnesium trisilicate, the antidiarrhoeals kaolin and pectin, the hypocholesterolaemic agent cholestyramine and the chemotoxins cyclophosphamide, vincristine and bleomycin. Certain antibiotics including sulphasalazine, neomycin and aminosalicylic acid reduce digoxin absorption while others, including erythromycin and tetracycline, increase the bioavailability of digoxin in some patients. Capsule preparations of digoxin in solution are less subject to several of the interactions which affect the absorption and bioavailability of digoxin tablets. Various drugs induce alterations in the volume of distribution and clearance of digoxin. Cardiac patients receiving digoxin therapy are particularly prone to interactions with commonly co-administered medications such as the antiarrhythmics quinidine and amiodarone, the calcium channel blockers verapamil and nifedipine, and possibly some vasodilating agents. Studies of digoxin interactions have yielded discrepant results, indicating the need for careful analysis of investigational design before arriving at clinical conclusions.

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Section: Non-steroidal Anti-inflammatory Drugsmentioning

confidence: 95%

Pharmacokinetic Interactions with Digoxin

Rodin

Johnson

1988

Clinical Pharmacokinetics

100

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“…Many of the studies that failed to demonstrate an interaction between NSAIDs and digoxin were performed in healthy volunteers whose renal function did not deteriorate during NSAID therapy (Fenster et al 1982;Finch et at. 1984;Verbeeck 1990).…”

Section: Digoxinmentioning

confidence: 97%

Adverse Drug Interactions with Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

1993

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The prevalence and incidence of adverse drug interactions involving nonsteroidal anti-inflammatory drugs (NSAIDs) remains unknown. To identify those proposed drug interactions of greatest clinical significance, it is appropriate to focus on interactions between commonly used and/or commonly coprescribed drugs, interactions for which there are numerous well documented case reports in reputable journals, interactions validated by well designed in vivo human studies and those affecting high-risk drugs and/or high-risk patients. While most interactions between NSAIDs and other drugs are pharmacokinetic, NSAID-related pharmacodynamic interactions may be considerably more important in the clinical context, and prescriber ignorance is likely to be a major determinant of many adverse drug interactions. Prescribing NSAIDs is relatively contraindicated for patients on oral anticoagulants due to the risk of haemorrhage, and for patients taking high-dose methotrexate due to the dangers of bone marrow toxicity, renal failure and hepatic dysfunction. Combination NSAID therapy cannot be justified as toxicity may be increased without any improvement in efficacy. Where lithium or anti-hypertensives are coprescribed with NSAIDs, close monitoring is mandatory for lithium toxicity and hypertension, respectively, and aspirin (acetylsalicylic acid) or sulindac are preferred. Phenytoin or oral hypoglycaemic agents may be administered with NSAIDs other than pyrazoles and salicylates provided that patients are monitored carefully at the initiation and cessation of NSAID treatment. Digoxin, aminoglycosides and probenecid may be coprescribed with NSAIDs, but close monitoring is required, particularly for high-risk patients such as the elderly. Indomethacin and triamterene should be avoided due to the risk of renal failure. High dose aspirin should be replaced by naproxen in patients on valproic acid (sodium valproate) and care is required when corticosteroids are administered to patients taking salicylates long term in high dosage. Interactions between NSAIDs and antacids or cholestyramine are generally avoidable. Adverse drug interactions involving NSAIDs may be limited by rational prescribing and by careful monitoring, particularly for high-risk patients, drugs and therapy periods.

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“…La preparación diluida debe ser administrada inmediatamente y el remanente debe ser descartado. La indometacina puede prolongar la vida media de digoxina, amikacina y gentamici-na [114][115][116][117][118][119][120][121][122] y es incompatible con aminoácidos, gluconato cálcico, dobutamina, dopamina y gentamicina. Es compatible con furosemida, insulina, cloruro potásico y bicarbonato de sodio 123 .…”

Section: Indometacinaunclassified

“…Los hallazgos son controvertidos, sin embargo, no lo son en cuanto al efecto diferencial de la administración en bolo frente a la infusión lenta 107,113,144,230 . Parece que el efecto de la indometacina sobre la reducción de la perfusión cerebral podría ser más precoz en el bolo que en la infusión lenta 114 , si bien no existen diferencias en el efecto global o en la duración de éste si el período de observación es más prolongado 114,147 , pero el período de observación fue corto en dos estudios (30 y 60 min) 108, 224 . Administrando cada dosis durante más de 30-60 min parecen limitarse algunos de los efectos negativos sobre el flujo sanguíneo.…”

Section: ¿Efectos Diferentes De Indometacina E Ibuprofeno En El Cerebunclassified