Skip to main content

Drug Interactions between Digox and Peganone

This report displays the potential drug interactions for the following 2 drugs:

Edit list (add/remove drugs)

Interactions between your drugs

Moderate

digoxin ethotoin

Applies to: Digox (digoxin) and Peganone (ethotoin)

MONITOR: Limited clinical data suggest that hydantoins may reduce digoxin serum levels. The mechanism of this interaction is unknown. Although phenytoin has been used in the treatment of digitalis-induced arrhythmias, it has been associated with cardiac arrest in patients with marked heart block.

MANAGEMENT: If these drugs are used concomitantly, close monitoring for clinical and laboratory evidence of altered digitalis effect is recommended. Occasionally, increases in the digoxin dosage may be necessary. The clinician should be aware that the risk of digoxin toxicity may be increased when a hydantoin is discontinued and should consider monitoring the patient more closely for those effects. Phenytoin should be avoided in patients with marked digoxin-induced heart block or bradycardia.

References

  1. Rumack BH, Wolfe RR, Gilfrich H "Phenytoin (diphenylhydantoin) treatment of massive digoxin overdose." Br Heart J 36 (1974): 405-8
  2. Rameis H "On the interaction between phenytoin and digoxin." Eur J Clin Pharmacol 29 (1985): 49-53
  3. Rameis H "The importance of prospective planning of pharmacokinetic trials. Considerations of studies on the phenytoin-digoxin-(P-D) and phenytoin-digitoxin-(P-DT) interaction." Int J Clin Pharmacol Ther Toxicol 30 (1992): 528-9
  4. Viukari NM, Aho K "Digoxin-phenytoin interaction." Br Med J 2 (1970): 51
  5. Solomon HM, Abrams WB "Interactions between digitoxin and other drugs in man." Am Heart J 83 (1972): 277-80
  6. Allonen H "The effect of phenytoin on the tissue concentrations of digoxin in the rat." Acta Pharmacol Toxicol (Copenh) 41 (1977): 481-8
  7. Allonen H, Iisalo E, Nuortio L "Effect of reserpine, desipramine and phenytoin on digoxin induced arrhythmias and myocardial uptake of digoxin in guinea pigs." Acta Pharmacol Toxicol (Copenh) 37 (1975): 8-16
  8. Rameis H "The importance of prospective planning of pharmacokinetic trials." Int J Clin Pharmacol Ther Toxicol 30 (1992): 528-9
  9. Solomon HM, Reich S, Spirt N, Abrams WB "Interactions between digitoxin and other drugs in vitro and in vivo." Ann N Y Acad Sci 179 (1971): 362-8
  10. "Product Information. Lanoxin (digoxin)." Glaxo Wellcome PROD (2001):
  11. "Product Information. Cerebyx (fosphenytoin)." Parke-Davis PROD (2001):
  12. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  13. Cerner Multum, Inc. "Australian Product Information." O 0
View all 13 references

Switch to consumer interaction data

Drug and food interactions

Moderate

ethotoin food

Applies to: Peganone (ethotoin)

ADJUST DOSING INTERVAL: Phenytoin bioavailability may decrease to subtherapeutic levels when the suspension is given concomitantly with enteral feedings. The mechanism may be related to phenytoin binding to substances in the enteral formula (e.g., calcium, protein) and/or binding to the tube lumen. Data have been conflicting and some studies have reported no changes in phenytoin levels, while others have reported significant reductions.

MONITOR: Acute consumption of alcohol may increase plasma phenytoin levels. Chronic consumption of alcohol may decrease plasma phenytoin levels. The mechanism of this interaction is related to induction of phenytoin metabolism by ethanol during chronic administration. Other hydantoin derivatives may be similarly affected by ethanol.

MANAGEMENT: Some experts have recommended interrupting the feeding for 2 hours before and after the phenytoin dose, giving the phenytoin suspension diluted in water, and flushing the tube with water after administration; however, this method may not entirely avoid the interaction and is not always clinically feasible. Patients should be closely monitored for clinical and laboratory evidence of altered phenytoin efficacy and levels upon initiation and discontinuation of enteral feedings. Dosage adjustments or intravenous administration may be required until therapeutic serum levels are obtained. In addition, patients receiving phenytoin therapy should be warned about the interaction between phenytoin and ethanol and they should be advised to notify their physician if they experience worsening of seizure control or symptoms of toxicity, including drowsiness, visual disturbances, change in mental status, nausea, or ataxia.

References

  1. Sandor P, Sellers EM, Dumbrell M, Khouw V "Effect of short- and long-term alcohol use on phenytoin kinetics in chronic alcoholics." Clin Pharmacol Ther 30 (1981): 390-7
  2. Holtz L, Milton J, Sturek JK "Compatibility of medications with enteral feedings." JPEN J Parenter Enteral Nutr 11 (1987): 183-6
  3. Sellers EM, Holloway MR "Drug kinetics and alcohol ingestion." Clin Pharmacokinet 3 (1978): 440-52
  4. "Product Information. Dilantin (phenytoin)." Parke-Davis PROD (2001):
  5. Doak KK, Haas CE, Dunnigan KJ, et al. "Bioavailability of phenytoin acid and phenytoin sodium with enteral feedings." Pharmacotherapy 18 (1998): 637-45
  6. Rodman DP, Stevenson TL, Ray TR "Phenytoin malabsorption after jejunostomy tube delivery." Pharmacotherapy 15 (1995): 801-5
  7. Au Yeung SC, Ensom MH "Phenytoin and enteral feedings: does evidence support an interaction?" Ann Pharmacother 34 (2000): 896-905
  8. Ozuna J, Friel P "Effect of enteral tube feeding on serum phenytoin levels." J Neurosurg Nurs 16 (1984): 289-91
  9. Faraji B, Yu PP "Serum phenytoin levels of patients on gastrostomy tube feeding." J Neurosci Nurs 30 (1998): 55-9
  10. Marvel ME, Bertino JS "Comparative effects of an elemental and a complex enteral feeding formulation on the absorption of phenytoin suspension." JPEN J Parenter Enteral Nutr 15 (1991): 316-8
  11. Fleisher D, Sheth N, Kou JH "Phenytoin interaction with enteral feedings administered through nasogastric tubes." JPEN J Parenter Enteral Nutr 14 (1990): 513-6
  12. Haley CJ, Nelson J "Phenytoin-enteral feeding interaction." DICP 23 (1989): 796-8
  13. Guidry JR, Eastwood TF, Curry SC "Phenytoin absorption in volunteers receiving selected enteral feedings." West J Med 150 (1989): 659-61
  14. Krueger KA, Garnett WR, Comstock TJ, Fitzsimmons WE, Karnes HT, Pellock JM "Effect of two administration schedules of an enteral nutrient formula on phenytoin bioavailability." Epilepsia 28 (1987): 706-12
  15. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  16. Cerner Multum, Inc. "Australian Product Information." O 0
View all 16 references

Switch to consumer interaction data

Minor

digoxin food

Applies to: Digox (digoxin)

Administration of digoxin with a high-fiber meal has been shown to decrease its bioavailability by almost 20%. Fiber can sequester up to 45% of the drug when given orally. Patients should be advised to maintain a regular diet without significant fluctuation in fiber intake while digoxin is being titrated.

Grapefruit juice may modestly increase the plasma concentrations of digoxin. The mechanism is increased absorption of digoxin due to mild inhibition of intestinal P-glycoprotein by certain compounds present in grapefruits. In 12 healthy volunteers, administration of grapefruit juice with and 30 minutes before, as well as 3.5, 7.5, and 11.5 hours after a single digoxin dose (0.5 mg) increased the mean area under the plasma concentration-time curve (AUC) of digoxin by just 9% compared to administration with water. Moreover, P-glycoprotein genetic polymorphism does not appear to influence the magnitude of the effects of grapefruit juice on digoxin. Thus, the interaction is unlikely to be of clinical significance.

References

  1. Darcy PF "Nutrient-drug interactions." Adverse Drug React Toxicol Rev 14 (1995): 233-54
  2. Becquemont L, Verstuyft C, Kerb R, et al. "Effect of grapefruit juice on digoxin pharmacokinetics in humans." Clin Pharmacol Ther 70 (2001): 311-6

Switch to consumer interaction data

Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

Report options

Loading...
QR code containing a link to this page

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer