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Drug Interactions between digoxin and Onfi

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

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Interactions between your drugs

Moderate

digoxin cloBAZam

Applies to: digoxin and Onfi (clobazam)

MONITOR: Benzodiazepines may increase serum levels of digoxin. The mechanism is unknown, but may be related to alterations of digoxin protein binding. Data have been conflicting; however, some cases of digoxin toxicity have been reported. Elderly patients may have a greater risk of developing toxicity.

MANAGEMENT: Close observation for clinical and laboratory evidence of digoxin toxicity is recommended if these drugs must be used together. Patients should be advised to notify their physician if they experience nausea, anorexia, visual disturbances, slow pulse, or irregular heartbeats.

References

  1. Ochs HR, Greenblatt DJ, Verburg-Ochs B (1985) "Effect of alprazolam on digoxin kinetics and creatinine clearance." Clin Pharmacol Ther, 38, p. 595-8
  2. Rodin SM, Johnson BF (1988) "Pharmacokinetic interactions with digoxin." Clin Pharmacokinet, 15, p. 227-44
  3. Tollefson G, Lesar T, Grothe D, Garvey M (1984) "Alprazolam-related digoxin toxicity." Am J Psychiatry, 141, p. 1612-3
  4. Castillo-Ferrando JR, Garcia M, Carmona J (1980) "Digoxin levels and diazepam." Lancet, 2, p. 368
  5. Castillo-Ferrando JR, Prieto AC, Brasas F (1983) "Effects of benzodiazepines on digoxin tissue concentrations and plasma protein binding." J Pharm Pharmacol, 35, p. 462-3
  6. Tollefson G, Lesar T, Grothe D, Garvey M (1984) "Alprazolam-related digoxin toxicity." Am J Psychiatry, 141, p. 1612-4
  7. Guven H, Tuncok Y, Guneri S, Cavdar C, Fowler J (1993) "Age-related digoxin-alprazolam interaction." Clin Pharmacol Ther, 54, p. 42-4
View all 7 references

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Drug and food interactions

Moderate

cloBAZam food

Applies to: Onfi (clobazam)

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

  1. Warrington SJ, Ankier SI, Turner P (1986) "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology, 15, p. 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P (1990) "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc.
  3. (2012) "Product Information. Fycompa (perampanel)." Eisai Inc
  4. (2015) "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc
View all 4 references

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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.

See also

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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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