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Drug Interactions between Aldactone and Cardoxin

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

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Interactions between your drugs

Minor

digoxin spironolactone

Applies to: Cardoxin (digoxin) and Aldactone (spironolactone)

Spironolactone may reduce the tubular secretion of digoxin. Plasma clearance of digoxin may be decreased, and plasma levels may increase. Also, limited data indicate that spironolactone may have a negative inotropic side effect. Finally, spironolactone may interfere with some digoxin radioimmunoassays, and digoxin concentrations may be overestimated. During coadministration, the patient should be monitored for signs and symptoms of digoxin toxicity, levels should be checked when necessary, and the clinician should keep in mind the possibility that digoxin levels may falsely appear to be elevated. Patients should be advised to notify their physician if they experience nausea, anorexia, visual changes, or irregular heartbeats.

References

  1. Wirth KE, Frolich JC, Hollifield JW, et al. "Metabolism of digitoxin in man and its modification by spironolactone." Eur J Clin Pharmacol 9 (1976): 345-54
  2. Rodin SM, Johnson BF "Pharmacokinetic interactions with digoxin." Clin Pharmacokinet 15 (1988): 227-44
  3. Hedman A, Angelin B, Arvidsson A, Dahlqvist R "Digoxin-interactions in man: spironolactone reduces renal but not biliary digoxin clearance." Eur J Clin Pharmacol 42 (1992): 481-5
  4. Morris RG, Lagnado PY, Lehmann DR, et al. "Spironolactone as a source of interference in commercial digoxin immunoassays." Ther Drug Monit 9 (1987): 208-11
  5. Fenster PE, Hager WD, Goodman MM "Digoxin-quinidine-spironolactone interaction." Clin Pharmacol Ther 36 (1984): 70-3
  6. Waldorff S, Hansen PB, Egeblad H, et al. "Interactions between digoxin and potassium-sparing diuretics." Clin Pharmacol Ther 33 (1983): 418-23
  7. de Cos MA, Gomez-Ullate J, Gomez F, Armijo JA "Time course of trough serum gentamicin concentrations in preterm and term neonates." Clin Pharmacokinet 23 (1992): 391-401
  8. Finnegan TP, Spence JD, Cape RD "Potassium-sparing diuretics: interaction with digoxin in elderly men." J Am Geriatr Soc 32 (1984): 129-31
  9. Paladino JA, Davidson KH, McCall BB "Influence of spironolactone on serum digoxin concentration ." JAMA 251 (1984): 470-1
  10. Hsieh YY, Lin MS, Chen JH, et al. "Spironolactone-digoxin interaction." Taiwan I Hsueh Hui Tsa Chih 82 (1983): 47-60
  11. Marcus FI "Pharmacokinetic interactions between digoxin and other drugs." J Am Coll Cardiol 5 (1985): a82-90
  12. DiPiro JT, Cote JR, DiPiro CR, Bustrack JA "Spironolactone interference with digoxin radioimmunoassay in cirrhotic patients." Am J Hosp Pharm 37 (1980): 1518-21
  13. Thomas RW, Maddox RR "The interaction of spironolactone and digoxin: a review and evaluation." Ther Drug Monit 3 (1981): 117-20
  14. Carruthers SG, Dujovne CA "Cholestyramine and spironolactone and their combination in digitoxin elimination." Clin Pharmacol Ther 27 (1980): 184-7
  15. Whang R, Oei TO, Watanabe A "Frequency of hypomagnesemia in hospitalized patients receiving digitalis." Arch Intern Med 145 (1985): 655-6
  16. Cohen L, Kitzes R "Magnesium Sulfate and digitalis-toxic arrhythmias." JAMA 249 (1983): 2808-10
  17. Waldorff S, Andersen JD, Heeboll-Nielsen N, et al. "Spironolactone-induced changes in digoxin kinetics." Clin Pharmacol Ther 24 (1978): 162-7
  18. Drescher S, Glaeser H, Murdter T, Hitzl M, Eichelbaum M, Fromm MF "P-glycoprotein-mediated intestinal and biliary digoxin transport in humans." Clin Pharmacol Ther 73 (2003): 223-31
  19. Balayssac D, Authier N, Cayre A, Coudore F "Does inhibition of P-glycoprotein lead to drug-drug interactions?" Toxicol Lett 156 (2005): 319-29
View all 19 references

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Drug and food interactions

Moderate

spironolactone food

Applies to: Aldactone (spironolactone)

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.

References

  1. Sternbach H "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol 11 (1991): 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med 101 (1984): 498-9
  3. Feder R "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry 52 (1991): 139
  4. Ellison JM, Milofsky JE, Ely E "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry 51 (1990): 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit 23 (2001): 435-40
  6. Cerner Multum, Inc. "Australian Product Information." O 0
  7. Pacher P, Kecskemeti V "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des 10 (2004): 2463-75
  8. Andrews C, Pinner G "Postural hypotension induced by paroxetine." BMJ 316 (1998): 595
View all 8 references

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Minor

digoxin food

Applies to: Cardoxin (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

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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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