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Drug Interactions between digitoxin and Mi-Acid II

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

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Minor

digitoxin aluminum hydroxide

Applies to: digitoxin and Mi-Acid II (aluminum hydroxide / magnesium hydroxide / simethicone)

Concurrent administration of antacids may decrease the oral bioavailability of digoxin and digitoxin. The mechanism of interaction is unknown. In ten healthy volunteers, administration of a single 0.75 mg dose of digoxin with 60 mL of antacid containing either 4% aluminum hydroxide gel, 8% magnesium hydroxide gel, or 8% magnesium trisilicate resulted in significantly reduced urinary excretion of digoxin (expressed as the percentage of original dose recovered) compared to administration without antacid. Specifically, the cumulative six-day urinary digoxin excretion was 40.1% for control, 30.7% for aluminum hydroxide, 27.1% for magnesium hydroxide, and 29.1% for magnesium trisilicate. In an in vitro study involving absorption across a physiological membrane, cumulative absorption of digoxin 0.25 mg was reduced 11.4% by aluminum hydroxide gel, 15.3% by light magnesium carbonate, and 99.5% by magnesium trisilicate. In a case report, an approximately 50% reduction in digoxin systemic exposure (AUC) was observed when digoxin was administered with 30 mL of an aluminum-magnesium hydroxide antacid and mexiletine. The interaction was attributed to the antacid, as mexiletine is not known to interact with digoxin. Some data also support a potential interaction with digitoxin. However, other studies have found no evidence of a significant interaction between digoxin and various antacids. Based on existing evidence, no special precautions appear necessary, although patients may consider separating the times of administration by 1 to 2 hours if an interaction is suspected.

References

  1. D'Arcy PF, McElnay JC "Drug-antacid interactions: assessment of clinical importance." Drug Intell Clin Pharm 21 (1987): 607-17
  2. Brown DD, Juhl RP "Decreased bioavailability of digoxin due to antacids and kaolin-pectin." N Engl J Med 295 (1976): 1034-7
  3. Rodin SM, Johnson BF "Pharmacokinetic interactions with digoxin." Clin Pharmacokinet 15 (1988): 227-44
  4. Bonelli J, Hruby K, Magometschnigg D, Hitzenberger G, Kaik G "The bio-availability of beta-acetyldigoxine alone and combined with aluminum hydroxide and magnesium hydroxide (Alucol)." Int J Clin Pharmacol Biopharm 15 (1977): 337-9
  5. Allen MD, Greenblatt DJ, Harmatz JS, Smith TW "Effect of magnesium--aluminum hydroxide and kaolin--pectin on absorption of digoxin from tablets and capsules." J Clin Pharmacol 21 (1981): 26-30
  6. Marcus FI "Pharmacokinetic interactions between digoxin and other drugs." J Am Coll Cardiol 5 (1985): a82-90
  7. McElnay JC, Harron DW, D'Arcy PF, Eagle MR "Interaction of digoxin with antacid constituents." Br Med J 1 (1978): 1554
  8. Saris SD, Lowenthal DT, Affrime MB "Steady-state digoxin concentration during oral mexiletine administration." Curr Ther Res Clin Exp 34 (1983): 662-6
  9. "Product Information. Suprep Bowel Prep Kit (magnesium/potassium/sodium sulfates)." Braintree Laboratories (2010):
View all 9 references

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Minor

digitoxin magnesium hydroxide

Applies to: digitoxin and Mi-Acid II (aluminum hydroxide / magnesium hydroxide / simethicone)

Concurrent administration of antacids may decrease the oral bioavailability of digoxin and digitoxin. The mechanism of interaction is unknown. In ten healthy volunteers, administration of a single 0.75 mg dose of digoxin with 60 mL of antacid containing either 4% aluminum hydroxide gel, 8% magnesium hydroxide gel, or 8% magnesium trisilicate resulted in significantly reduced urinary excretion of digoxin (expressed as the percentage of original dose recovered) compared to administration without antacid. Specifically, the cumulative six-day urinary digoxin excretion was 40.1% for control, 30.7% for aluminum hydroxide, 27.1% for magnesium hydroxide, and 29.1% for magnesium trisilicate. In an in vitro study involving absorption across a physiological membrane, cumulative absorption of digoxin 0.25 mg was reduced 11.4% by aluminum hydroxide gel, 15.3% by light magnesium carbonate, and 99.5% by magnesium trisilicate. In a case report, an approximately 50% reduction in digoxin systemic exposure (AUC) was observed when digoxin was administered with 30 mL of an aluminum-magnesium hydroxide antacid and mexiletine. The interaction was attributed to the antacid, as mexiletine is not known to interact with digoxin. Some data also support a potential interaction with digitoxin. However, other studies have found no evidence of a significant interaction between digoxin and various antacids. Based on existing evidence, no special precautions appear necessary, although patients may consider separating the times of administration by 1 to 2 hours if an interaction is suspected.

References

  1. D'Arcy PF, McElnay JC "Drug-antacid interactions: assessment of clinical importance." Drug Intell Clin Pharm 21 (1987): 607-17
  2. Brown DD, Juhl RP "Decreased bioavailability of digoxin due to antacids and kaolin-pectin." N Engl J Med 295 (1976): 1034-7
  3. Rodin SM, Johnson BF "Pharmacokinetic interactions with digoxin." Clin Pharmacokinet 15 (1988): 227-44
  4. Bonelli J, Hruby K, Magometschnigg D, Hitzenberger G, Kaik G "The bio-availability of beta-acetyldigoxine alone and combined with aluminum hydroxide and magnesium hydroxide (Alucol)." Int J Clin Pharmacol Biopharm 15 (1977): 337-9
  5. Allen MD, Greenblatt DJ, Harmatz JS, Smith TW "Effect of magnesium--aluminum hydroxide and kaolin--pectin on absorption of digoxin from tablets and capsules." J Clin Pharmacol 21 (1981): 26-30
  6. Marcus FI "Pharmacokinetic interactions between digoxin and other drugs." J Am Coll Cardiol 5 (1985): a82-90
  7. McElnay JC, Harron DW, D'Arcy PF, Eagle MR "Interaction of digoxin with antacid constituents." Br Med J 1 (1978): 1554
  8. Saris SD, Lowenthal DT, Affrime MB "Steady-state digoxin concentration during oral mexiletine administration." Curr Ther Res Clin Exp 34 (1983): 662-6
  9. "Product Information. Suprep Bowel Prep Kit (magnesium/potassium/sodium sulfates)." Braintree Laboratories (2010):
View all 9 references

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Drug and food interactions

Major

aluminum hydroxide food

Applies to: Mi-Acid II (aluminum hydroxide / magnesium hydroxide / simethicone)

GENERALLY AVOID: The concomitant administration of aluminum-containing products (e.g., antacids and phosphate binders) and citrates may significantly increase serum aluminum concentrations, resulting in toxicity. Citrates or citric acid are contained in numerous soft drinks, citrus fruits, juices, and effervescent and dispersible drug formulations. Citrates enhance the gastrointestinal absorption of aluminum by an unknown mechanism, which may involve the formation of a soluble aluminum-citrate complex. Various studies have reported that citrate increases aluminum absorption by 4.6- to 50-fold in healthy subjects. Patients with renal insufficiency are particularly at risk of developing hyperaluminemia and encephalopathy. Fatalities have been reported. Patients with renal failure or on hemodialysis may also be at risk from soft drinks and effervescent and dispersible drug formulations that contain citrates or citric acid. It is unknown what effect citrus fruits or juices would have on aluminum absorption in healthy patients.

MANAGEMENT: The concomitant use of aluminum- and citrate-containing products and foods should be avoided by renally impaired patients. Hemodialysis patients should especially be cautioned about effervescent and dispersible over-the-counter remedies and soft drinks. Some experts also recommend that healthy patients should separate doses of aluminum-containing antacids and citrates by 2 to 3 hours.

ADJUST DOSING INTERVAL: The administration of aluminum-containing antacids with enteral nutrition may result in precipitation, formation of bezoars, and obstruction of feeding tubes. The proposed mechanism is the formation of an insoluble complex between the aluminum and the protein in the enteral feeding. Several cases of esophageal plugs and nasogastric tube obstructions have been reported in patients receiving high-protein liquids and an aluminum hydroxide-magnesium hydroxide antacid or an aluminum hydroxide antacid.

MANAGEMENT: Some experts recommend that antacids should not be mixed with or given after high protein formulations, that the antacid dose should be separated from the feeding by as much as possible, and that the tube should be thoroughly flushed before administration.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  2. Wohlt PD, Zheng L, Gunderson S, Balzar SA, Johnson BD, Fish JT "Recommendations for the use of medications with continuous enteral nutrition." Am J Health Syst Pharm 66 (2009): 1438-67

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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

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