Drug Interactions between digitoxin and Prepopik
This report displays the potential drug interactions for the following 2 drugs:
- digitoxin
- Prepopik (citric acid/magnesium oxide/sodium picosulfate)
Interactions between your drugs
digitoxin magnesium oxide
Applies to: digitoxin and Prepopik (citric acid/magnesium oxide/sodium picosulfate)
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
- D'Arcy PF, McElnay JC (1987) "Drug-antacid interactions: assessment of clinical importance." Drug Intell Clin Pharm, 21, p. 607-17
- Brown DD, Juhl RP (1976) "Decreased bioavailability of digoxin due to antacids and kaolin-pectin." N Engl J Med, 295, p. 1034-7
- Rodin SM, Johnson BF (1988) "Pharmacokinetic interactions with digoxin." Clin Pharmacokinet, 15, p. 227-44
- Bonelli J, Hruby K, Magometschnigg D, Hitzenberger G, Kaik G (1977) "The bio-availability of beta-acetyldigoxine alone and combined with aluminum hydroxide and magnesium hydroxide (Alucol)." Int J Clin Pharmacol Biopharm, 15, p. 337-9
- Allen MD, Greenblatt DJ, Harmatz JS, Smith TW (1981) "Effect of magnesium--aluminum hydroxide and kaolin--pectin on absorption of digoxin from tablets and capsules." J Clin Pharmacol, 21, p. 26-30
- Marcus FI (1985) "Pharmacokinetic interactions between digoxin and other drugs." J Am Coll Cardiol, 5, a82-90
- McElnay JC, Harron DW, D'Arcy PF, Eagle MR (1978) "Interaction of digoxin with antacid constituents." Br Med J, 1, p. 1554
- Saris SD, Lowenthal DT, Affrime MB (1983) "Steady-state digoxin concentration during oral mexiletine administration." Curr Ther Res Clin Exp, 34, p. 662-6
- (2010) "Product Information. Suprep Bowel Prep Kit (magnesium/potassium/sodium sulfates)." Braintree Laboratories
digitoxin sodium picosulfate
Applies to: digitoxin and Prepopik (citric acid/magnesium oxide/sodium picosulfate)
Due to a potential risk of water or electrolyte imbalance, the manufacturer recommends caution during concomitant administration of sodium picosulfate with cardiac glycosides, lithium, nonsteroidal anti-inflammatory agents, or drugs which may cause SIADH. The clinical significance is unknown.
References
- Cerner Multum, Inc. "UK Summary of Product Characteristics."
Drug and food interactions
sodium picosulfate food
Applies to: Prepopik (citric acid/magnesium oxide/sodium picosulfate)
ADJUST DOSING INTERVAL: Bowel cleansing products can increase the gastrointestinal transit rate. Oral medications administered within one hour of the start of administration of the bowel cleansing solution may be flushed from the gastrointestinal tract and not properly absorbed.
MANAGEMENT: Patients should be advised that absorption of oral medications may be impaired during bowel cleansing treatment. Oral medications (e.g., anticonvulsants, oral contraceptives, antidiabetic agents, antibiotics) should not be administered during and within one hour of starting bowel cleansing treatment whenever possible. However, if concomitant use cannot be avoided, monitoring for reduced therapeutic effects may be advisable.
References
- "Product Information. Golytely (polyethylene glycol 3350 with electrolytes)." Braintree
- (2022) "Product Information. Prepopik (citric acid/Mg oxide/Na picosulfate)." Ferring Pharmaceuticals Inc
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
Drug Interaction Classification
Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
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. | |
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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