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Drug Interactions between Digitek and eravacycline

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

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Interactions between your drugs

Major

digoxin eravacycline

Applies to: Digitek (digoxin) and eravacycline

MONITOR CLOSELY: Tetracyclines may increase serum levels of orally administered digoxin by preventing specific bacteria, present in the lower intestine, from inactivating digoxin. About 10% of the population use this mechanism to metabolize digoxin. When digoxin was administered with tetracycline in a pharmacokinetic study done in adults, the digoxin serum concentration increased by 100%. Currently there is no data demonstrating the effects of other tetracyclines on digoxin levels. The risk of an interaction may be less with digoxin solution in capsules because absorption occurs in the upper GI tract.

MANAGEMENT: Close clinical monitoring of digoxin serum concentration as well as signs or symptoms of digoxin toxicity are recommended when antibiotic therapy is initiated or discontinued. It is advisable to obtain a baseline digoxin level prior to initiating concomitant therapy. Some authorities recommend reducing the digoxin dose by around 30% to 50% or modifying the dosing frequency, followed by additional monitoring. Patients should be advised to notify their physicians if they experience nausea, anorexia, fatigue, visual changes, slow pulse, and/or irregular heartbeats.

References (9)
  1. Lindenbaum J, Rund DG, Butler VP Jr, Tse-Eng D, Saha JR (1981) "Inactivation of digoxin by the gut flora: reversal by antibiotic therapy." N Engl J Med, 305, p. 789-94
  2. Lindenbaum J, Tse-Eng D, Butler VP, Rund DG (1981) "Urinary excretion of reduced metabolites of digoxin." Am J Med, 71, p. 67-74
  3. Rodin SM, Johnson BF (1988) "Pharmacokinetic interactions with digoxin." Clin Pharmacokinet, 15, p. 227-44
  4. (2019) "Product Information. Digoxin (digoxin)." Amneal Pharmaceuticals LLC
  5. (2022) "Product Information. PMS-Digoxin (digoxin)." Pharmascience Inc
  6. (2022) "Product Information. Digoxin (digoxin)." Aspen Pharma Trading Ltd
  7. (2020) "Product Information. Sigmaxin (digoxin)." (Obsolete) Aspen Pharma Pty Ltd
  8. MacLeod-Glover N, Mink M, Yarema M, Chuang R (2016) "Digoxin toxicity: case for retiring its use in elderly patients?" Can Fam Physician, 62, p. 223-8
  9. Zhanel GG, cheung d, Adam H, et al. (2016) "Review of eravacycline, a novel fluorocycline antibacterial agent." Drugs, 76, p. 567-88

Drug and food interactions

Minor

digoxin food

Applies to: Digitek (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 (2)
  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

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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