Drug Interactions between digitoxin 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.