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Drug Interactions between digoxin and Fosrenol

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

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Interactions between your drugs

Moderate

digoxin lanthanum carbonate

Applies to: digoxin and Fosrenol (lanthanum carbonate)

ADJUST DOSING INTERVAL: Theoretically, lanthanum carbonate may chelate with certain drugs in the gastrointestinal tract, resulting in reduced oral bioavailability of those drugs during coadministration. However, an in vitro study involving digoxin, enalapril, furosemide, metoprolol, phenytoin, and warfarin found no evidence that lanthanum carbonate forms insoluble complexes with these drugs in simulated gastric fluid. Studies in healthy subjects have also found no effect of lanthanum carbonate (1000 mg for 4 doses) on the absorption of a single dose of digoxin (0.5 mg), metoprolol (100 mg), or warfarin (10 mg).

MANAGEMENT: To minimize the potential for interaction, drugs that are known to interact with antacids (e.g., ACE inhibitors, beta blockers, bisphosphonates, coumarin derivatives, digitalis glycosides, fluoroquinolones, iron, phenytoin, rifampin, tetracyclines, thyroid preparations) should not be taken within 2 hours of administration of lanthanum carbonate according to the product labeling.

References

  1. (2004) "Product Information. Fosrenol (lanthanum carbonate)." Shire US Inc
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  3. Canadian Pharmacists Association (2006) e-CPS. http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink
  4. Cerner Multum, Inc. "Australian Product Information."
  5. (2018) "Product Information. Seysara (sarecycline)." Allergan Inc
  6. (2018) "Product Information. Nuzyra (omadacycline)." Paratek Pharmaceuticals, Inc.
View all 6 references

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Drug and food interactions

Moderate

lanthanum carbonate food

Applies to: Fosrenol (lanthanum carbonate)

GENERALLY AVOID: Lanthanum carbonate should be administered with food for therapeutic efficacy. However, it is insoluble in water (<0.01 mg/mL at pH 7.5) and therefore cannot be dissolved in liquid for administration through an enteral feeding tube, because it may result in blockage of the tube.

MANAGEMENT: Administration of lanthanum carbonate with enteral feedings is not recommended. Alternative medications such as calcium carbonate suspension should be considered.

References

  1. Wohlt PD, Zheng L, Gunderson S, Balzar SA, Johnson BD, Fish JT (2009) "Recommendations for the use of medications with continuous enteral nutrition." Am J Health Syst Pharm, 66, p. 1438-67

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Minor

digoxin food

Applies to: 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 (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

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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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