Skip to main content

Drug Interactions between digoxin and telmisartan

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

Edit list (add/remove drugs)

Interactions between your drugs

Moderate

digoxin telmisartan

Applies to: digoxin and telmisartan

MONITOR: Coadministration with telmisartan may modestly increase the serum concentrations of digoxin. The exact mechanism of interaction is unknown. In twelve healthy volunteers, telmisartan (120 mg orally once a day for 7 days) increased the steady state peak serum concentration (Cmax), area under the concentration-time curve (AUC) and trough concentration (Cmin) of digoxin (0.5 mg orally once, then 0.25 mg once a day for 7 days) by 50%, 22%, and 13%, respectively, compared to administration of digoxin alone. These changes are not thought to be clinically significant, although patients with serum digoxin levels at the upper end of the therapeutic range may be at increased risk for digoxin toxicity. Digoxin did not affect the steady-state pharmacokinetics of telmisartan, and coadministration had no effect on the safety and tolerability of either drug.

MANAGEMENT: Pharmacologic response and serum digoxin levels should be monitored more closely following initiation, discontinuation, or change of dosage of telmisartan in patients who are stabilized on their digoxin regimen. Patients should be advised to contact their physician if they experience signs and symptoms of digoxin toxicity such as nausea, anorexia, visual disturbances, slow pulse, or irregular heartbeat.

References

  1. (2001) "Product Information. Micardis (telmisartan)." Boehringer-Ingelheim
  2. Stangier J, Su CAPF, Hendriks MGC, vanLier JJ, Sollie FAE, Oosterhuis B, Jonkman JHG (2000) "The effect of telmisartan on the steady-state pharmacokinetics of digoxin in healthy male volunteers." J Clin Pharmacol, 40, p. 1373-9

Switch to consumer interaction data

Drug and food interactions

Moderate

telmisartan food

Applies to: telmisartan

GENERALLY AVOID: Moderate-to-high dietary intake of potassium, especially salt substitutes, may increase the risk of hyperkalemia in some patients who are using angiotensin II receptor blockers (ARBs). ARBs can promote hyperkalemia through inhibition of angiotensin II-induced aldosterone secretion. Patients with diabetes, heart failure, dehydration, or renal insufficiency have a greater risk of developing hyperkalemia.

MANAGEMENT: Patients should receive dietary counseling and be advised to not use potassium-containing salt substitutes or over-the-counter potassium supplements without consulting their physician. If salt substitutes are used concurrently, regular monitoring of serum potassium levels is recommended. Patients should also be advised to seek medical attention if they experience symptoms of hyperkalemia such as weakness, irregular heartbeat, confusion, tingling of the extremities, or feelings of heaviness in the legs.

References

  1. (2001) "Product Information. Cozaar (losartan)." Merck & Co., Inc
  2. (2001) "Product Information. Diovan (valsartan)." Novartis Pharmaceuticals

Switch to consumer interaction data

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

Switch to consumer interaction data

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

Report options

Loading...
QR code containing a link to this page

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.

Medical Disclaimer