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Drug Interactions between digoxin and Neo-Tab

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

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Interactions between your drugs

Minor

digoxin neomycin

Applies to: digoxin and Neo-Tab (neomycin)

Oral neomycin has been shown to decrease the absorption of oral digoxin. The effects of oral paromomycin and kanamycin are not known. The proposed mechanism is a neomycin-induced malabsorption syndrome resulting in reduced absorption of drugs. This effect may be offset by a subsequent decrease in digoxin metabolism. During concomitant therapy with any of these antibiotics, digoxin serum concentrations and efficacy should be monitored. Patients should be advised to notify their physician if they experience a worsening of their heart symptoms.

References

  1. Lindenbaum J, Tse-Eng D, Butler VP, Rund DG (1981) "Urinary excretion of reduced metabolites of digoxin." Am J Med, 71, p. 67-74
  2. Rodin SM, Johnson BF (1988) "Pharmacokinetic interactions with digoxin." Clin Pharmacokinet, 15, p. 227-44
  3. Lindenbaum J, Maulitz RM, Butler VP (1976) "Inhibition of digoxin absorption by neomycin." Gastroenterology, 71, p. 399-404

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Drug and food interactions

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.

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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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