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Drug Interactions between digoxin and ginseng

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

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Interactions between your drugs

Moderate

digoxin ginseng

Applies to: digoxin and ginseng

GENERALLY AVOID: Asian and Siberian ginseng may interfere with digoxin either pharmacodynamically or with its monitoring via certain immunoassays. The interaction has been observed in vitro as well as in nondigoxin-treated mice that were fed ginseng and is thought to be due to substances in the ginseng that structurally resemble cardiac glycosides. Serum pools prepared from samples from patients receiving digoxin and then supplemented with Asian or Siberian ginseng also demonstrated interference. In one case report, a 74-year-old man who had been taking a constant dose of digoxin for many years was found during a routine office visit to have unexplained elevated serum digoxin level with no clinical signs of toxicity. The level remained high even after stopping the drug, whereupon the patient revealed that he had been taking a Siberian ginseng capsule. Soon after discontinuation of the capsules, serum digoxin returned to an acceptable level and therapy was resumed. Digoxin level again rose several months later when the patient resumed taking the ginseng but fell to within therapeutic range shortly after he stopped, despite continued therapy with digoxin at the same dosage. No analysis was performed to determine whether the capsules actually contained Siberian ginseng and if so, at what concentration.

MANAGEMENT: Patients should consult a healthcare provider before taking any herbal or alternative medicine. Use of ginseng should probably be avoided in patients treated with cardiac glycosides.

References

  1. Miller LG (1998) "Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions." Arch Intern Med, 158, p. 2200-11
  2. McRae S (1996) "Elevated serum digoxin levels in a patient taking digoxin and Siberian ginseng." CMAJ, 155, p. 293-5
  3. Dasgupta A, Wu S, Actor J, Olsen M, Wells A, Datta P (2003) "Effect of Asian and Siberian ginseng on serum digoxin measurement by five digoxin immunoassays. Significant variation in digoxin-like immunoreactivity among commercial ginsengs." Am J Clin Pathol, 119, p. 298-303

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Drug and food interactions

Minor

digoxin food

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

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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.

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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.

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