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Drug Interactions between Cytosar and Lanoxin

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

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Interactions between your drugs

Moderate

cytarabine digoxin

Applies to: Cytosar (cytarabine) and Lanoxin (digoxin)

MONITOR: The use of some antineoplastic agents has been associated with decreased gastrointestinal absorption of digoxin. The suspected mechanism is alteration of the gastrointestinal mucosa. The risk of an interaction is expected to be less with digoxin solution in capsules because absorption occurs rapidly in the upper GI tract.

MANAGEMENT: Digoxin serum levels and effectiveness should be monitored closely following the initiation or discontinuation of antineoplastic agents, and the dosage adjusted as necessary.

References

  1. Rodin SM, Johnson BF "Pharmacokinetic interactions with digoxin." Clin Pharmacokinet 15 (1988): 227-44
  2. Kuhlmann J, Wilke J, Rietbrock N "Cytostatic drugs are without significant effect on digitoxin plasma level and renal excretion." Clin Pharmacol Ther 32 (1982): 646-51
  3. Bjornsson TD, Huang AT, Roth P, Jacob DS, Christenson R "Effects of high-dose cancer chemotherapy on the absorption of digoxin in two different formulations." Clin Pharmacol Ther 39 (1986): 25-8
  4. Kuhlmann J, Zilly W, Wilke J "Effects of cytostatic drugs on plasma level and renal excretion of beta-acetyldigoxin." Clin Pharmacol Ther 30 (1981): 518-27
  5. "Product Information. Lanoxicaps (digoxin)." Glaxo Wellcome (2001):
View all 5 references

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Drug and food interactions

Minor

digoxin food

Applies to: Lanoxin (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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