Drug Interactions between digoxin and isoproterenol / phenylephrine
This report displays the potential drug interactions for the following 2 drugs:
- digoxin
- isoproterenol/phenylephrine
Interactions between your drugs
digoxin isoproterenol
Applies to: digoxin and isoproterenol / phenylephrine
MONITOR: The concomitant use of sympathomimetic agents and cardiac glycosides may increase the risk of cardiac arrhythmias. The mechanism of this interaction is not known. Increased ectopic pacemaker activity has been reported to occur in patients taking digoxin in combination with pseudoephedrine.
MANAGEMENT: Caution should be exercised if these two drugs are coadministered. Electrocardiogram monitoring (ECG) is recommended. The use of epinephrine (adrenaline) with high doses of digitalis glycosides is not recommended.
References
- "Product Information. Isuprel (isoproterenol)." Sanofi Winthrop Pharmaceuticals PROD (2001):
- "Product Information. Lanoxin (digoxin)." Glaxo Wellcome PROD (2001):
- "Product Information. EPINEPHrine Hydrochloride (EPINEPHrine)." Abbott Pharmaceutical (2022):
- "Product Information. Claritin-D (loratadine-pseudoephedrine)." Schering-Plough PROD (2001):
- "Product Information. Allegra-D (fexofenadine-pseudoephedrine)." Chattem Consumer Products PROD (2001):
- Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
- Cerner Multum, Inc. "Australian Product Information." O 0
digoxin phenylephrine
Applies to: digoxin and isoproterenol / phenylephrine
MONITOR: The concomitant use of sympathomimetic agents and cardiac glycosides may increase the risk of cardiac arrhythmias. The mechanism of this interaction is not known. Increased ectopic pacemaker activity has been reported to occur in patients taking digoxin in combination with pseudoephedrine.
MANAGEMENT: Caution should be exercised if these two drugs are coadministered. Electrocardiogram monitoring (ECG) is recommended. The use of epinephrine (adrenaline) with high doses of digitalis glycosides is not recommended.
References
- "Product Information. Isuprel (isoproterenol)." Sanofi Winthrop Pharmaceuticals PROD (2001):
- "Product Information. Lanoxin (digoxin)." Glaxo Wellcome PROD (2001):
- "Product Information. EPINEPHrine Hydrochloride (EPINEPHrine)." Abbott Pharmaceutical (2022):
- "Product Information. Claritin-D (loratadine-pseudoephedrine)." Schering-Plough PROD (2001):
- "Product Information. Allegra-D (fexofenadine-pseudoephedrine)." Chattem Consumer Products PROD (2001):
- Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
- Cerner Multum, Inc. "Australian Product Information." O 0
isoproterenol phenylephrine
Applies to: isoproterenol / phenylephrine and isoproterenol / phenylephrine
MONITOR: Coadministration of beta-2 adrenergic agonists with other adrenergic agents may potentiate the risk of cardiovascular side effects. Beta-2 adrenergic agonists can produce clinically significant cardiovascular effects including increases in pulse rate and systolic or diastolic blood pressure as well as ECG changes such as flattening of the T wave, prolongation of the QTc interval, and ST segment depression. The risk is lower when beta-2 adrenergic agonists are inhaled at normally recommended dosages. However, these effects may be more common when the drugs are administered systemically or when recommended dosages are exceeded.
MANAGEMENT: Caution is advised if beta-2 adrenergic agonists are used concomitantly with other adrenergic agents, particularly in patients with cardiovascular disorders such as coronary insufficiency, cardiac arrhythmias, hypertrophic obstructive cardiomyopathy, or hypertension. Blood pressure and heart rate should be closely monitored.
References
- Wong CS, Pavord ID, Williams J, Britton JR, Tattersfield AE "Bronchodilator, cardiovascular, and hypokalaemic effects of fenoterol, salbutamol, and terbutaline in asthma." Lancet 336 (1990): 1396-9
- "Product Information. Proventil (albuterol)." Schering Corporation PROD (2002):
- "Product Information. Serevent (salmeterol)." Glaxo Wellcome PROD
- "Product Information. Maxair (pirbuterol)." 3M Pharmaceuticals PROD (2001):
- "Product Information. Xopenex (levalbuterol)." Sepracor Inc PROD (2001):
- "Product Information. Foradil (formoterol)." Novartis Pharmaceuticals PROD (2001):
- "Product Information. Brovana (arformoterol)." Sepracor Inc (2006):
- Lowe MD, Rowland E, Brown MJ, Grace AA "Beta(2) adrenergic receptors mediate important electrophysiological effects in human ventricular myocardium." Heart 86 (2001): 45-51
- "Product Information. Arcapta Neohaler (indacaterol)." Novartis Pharmaceuticals (2011):
- "Product Information. Breo Ellipta (fluticasone-vilanterol)." GlaxoSmithKline (2013):
- "Product Information. Striverdi Respimat (olodaterol)." Boehringer Ingelheim (2014):
Drug and food interactions
isoproterenol food
Applies to: isoproterenol / phenylephrine
MONITOR: Coadministration of two or more sympathomimetic agents may increase the risk of adverse effects such as nervousness, irritability, and increased heart rate. Central nervous system (CNS) stimulants, particularly amphetamines, can potentiate the adrenergic response to vasopressors and other sympathomimetic agents. Additive increases in blood pressure and heart rate may occur due to enhanced peripheral sympathetic activity.
MANAGEMENT: Caution is advised if two or more sympathomimetic agents are coadministered. Pulse and blood pressure should be closely monitored.
References
- Rosenblatt JE, Lake CR, van Kammen DP, Ziegler MG, Bunney WE Jr "Interactions of amphetamine, pimozide, and lithium on plasma norepineophrine and dopamine-beta-hydroxylase in schizophrenic patients." Psychiatry Res 1 (1979): 45-52
- Cavanaugh JH, Griffith JD, Oates JA "Effect of amphetamine on the pressor response to tyramine: formation of p-hydroxynorephedrine from amphetamine in man." Clin Pharmacol Ther 11 (1970): 656
- "Product Information. Adderall (amphetamine-dextroamphetamine)." Shire Richwood Pharmaceutical Company Inc PROD (2001):
- "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals PROD (2001):
- "Product Information. Sanorex (mazindol)." Novartis Pharmaceuticals PROD (2001):
- "Product Information. Focalin (dexmethylphenidate)." Mikart Inc (2001):
- "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company (2002):
phenylephrine food
Applies to: isoproterenol / phenylephrine
MONITOR: Coadministration of two or more sympathomimetic agents may increase the risk of adverse effects such as nervousness, irritability, and increased heart rate. Central nervous system (CNS) stimulants, particularly amphetamines, can potentiate the adrenergic response to vasopressors and other sympathomimetic agents. Additive increases in blood pressure and heart rate may occur due to enhanced peripheral sympathetic activity.
MANAGEMENT: Caution is advised if two or more sympathomimetic agents are coadministered. Pulse and blood pressure should be closely monitored.
References
- Rosenblatt JE, Lake CR, van Kammen DP, Ziegler MG, Bunney WE Jr "Interactions of amphetamine, pimozide, and lithium on plasma norepineophrine and dopamine-beta-hydroxylase in schizophrenic patients." Psychiatry Res 1 (1979): 45-52
- Cavanaugh JH, Griffith JD, Oates JA "Effect of amphetamine on the pressor response to tyramine: formation of p-hydroxynorephedrine from amphetamine in man." Clin Pharmacol Ther 11 (1970): 656
- "Product Information. Adderall (amphetamine-dextroamphetamine)." Shire Richwood Pharmaceutical Company Inc PROD (2001):
- "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals PROD (2001):
- "Product Information. Sanorex (mazindol)." Novartis Pharmaceuticals PROD (2001):
- "Product Information. Focalin (dexmethylphenidate)." Mikart Inc (2001):
- "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company (2002):
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
- Darcy PF "Nutrient-drug interactions." Adverse Drug React Toxicol Rev 14 (1995): 233-54
- Becquemont L, Verstuyft C, Kerb R, et al. "Effect of grapefruit juice on digoxin pharmacokinetics in humans." Clin Pharmacol Ther 70 (2001): 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.
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
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