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Drug Interactions between Caltro with Vitamin D and digitoxin

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

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Interactions between your drugs

Moderate

digitoxin calcium carbonate

Applies to: digitoxin and Caltro with Vitamin D (calcium / vitamin d)

MONITOR: Excessive administration of calcium can aggravate digitalis toxicity and precipitate serious cardiac arrhythmias in digitalised patients. The mechanism probably involves additive or synergistic inotropic effects of calcium and digitalis glycosides on the myocardium.

MANAGEMENT: Caution is advised if calcium preparations are used in patients receiving digitalis glycosides. Patients should be advised not to exceed the calcium dosage prescribed for them and to consult their healthcare provider before consuming additional products that may contain substantial amounts of calcium (e.g., over-the-counter supplements).

References

  1. (2001) "Product Information. PhosLo (calcium acetate)." Braintree

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Moderate

digitoxin ergocalciferol

Applies to: digitoxin and Caltro with Vitamin D (calcium / vitamin d)

MONITOR: Excessive dosing of vitamin D can induce hypercalcemia, which may increase the risk of digitalis toxicity and serious arrhythmias due to additive inotropic effects.

MANAGEMENT: Caution is advised if digitalis compounds are used concomitantly with vitamin D or vitamin D analogs. Serum digoxin, calcium, and phosphorus levels should be closely monitored, especially early in treatment during dosage adjustment. The serum calcium X phosphorus product should be maintained at less than 55 in patients with chronic kidney disease and should not be allowed to exceed 70 in any patient. An estimate of daily dietary calcium intake should be made and the intake adjusted when indicated. Patients should be advised to avoid an abrupt increase in dietary calcium intake, as it may trigger hypercalcemia, and to contact their physician if they experience early symptoms of vitamin D intoxication associated with hypercalcemia such as weakness, fatigue, headache, somnolence, vertigo, tinnitus, anorexia, nausea, vomiting, constipation, dry mouth, metallic taste, muscle pain, bone pain, ataxia, and hypotonia. Late symptoms may include polyuria, polydipsia, weight loss, nocturia, conjunctivitis, photophobia, rhinorrhea, pruritus, hyperthermia, decreased libido, and cardiac arrhythmias. Patients should also seek medical attention if they experience signs of digoxin toxicity such as nausea, anorexia, visual disturbances, slow pulse, or irregular heartbeats.

References

  1. (2001) "Product Information. Rocaltrol (calcitriol)." Roche Laboratories
  2. (2001) "Product Information. Zemplar (paricalcitol)." Abbott Pharmaceutical
  3. (2004) "Product Information. Hectorol (doxercalciferol)." Genzyme Corporation
  4. (2004) "Product Information. One-Alpha (alfacalcidol)." Pharmel Inc
  5. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  6. Therapeutic Research Faculty (2008) Natural Medicines Comprehensive Database. http://www.naturaldatabase.com
View all 6 references

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Drug and food interactions

Moderate

calcium carbonate food

Applies to: Caltro with Vitamin D (calcium / vitamin d)

ADJUST DOSING INTERVAL: Administration with food may increase the absorption of calcium. However, foods high in oxalic acid (spinach or rhubarb), or phytic acid (bran and whole grains) may decrease calcium absorption.

MANAGEMENT: Calcium may be administered with food to increase absorption. Consider withholding calcium administration for at least 2 hours before or after consuming foods high in oxalic acid or phytic acid.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  2. Canadian Pharmacists Association (2006) e-CPS. http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink
  3. Cerner Multum, Inc. "Australian Product Information."
  4. Agencia Española de Medicamentos y Productos Sanitarios Healthcare (2008) Centro de información online de medicamentos de la AEMPS - CIMA. https://cima.aemps.es/cima/publico/home.html
  5. Mangels AR (2014) "Bone nutrients for vegetarians." Am J Clin Nutr, 100, epub
  6. Davies NT (1979) "Anti-nutrient factors affecting mineral utilization." Proc Nutr Soc, 38, p. 121-8
View all 6 references

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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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