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Drug Interactions between Lanoxin and Rayaldee

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

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Interactions between your drugs

Moderate

digoxin calcifediol

Applies to: Lanoxin (digoxin) and Rayaldee (calcifediol)

MONITOR: Excessive dosing of vitamin D can induce hypercalcemia, which may increase the risk of digitalis toxicity and serious arrhythmias due to additive inotropic effects.

MANAGEMENT: Caution is advised if digitalis compounds are used concomitantly with vitamin D or vitamin D analogs. Serum digoxin, calcium, and phosphorus levels should be closely monitored, especially early in treatment during dosage adjustment. The serum calcium X phosphorus product should be maintained at less than 55 in patients with chronic kidney disease and should not be allowed to exceed 70 in any patient. An estimate of daily dietary calcium intake should be made and the intake adjusted when indicated. Patients should be advised to avoid an abrupt increase in dietary calcium intake, as it may trigger hypercalcemia, and to contact their physician if they experience early symptoms of vitamin D intoxication associated with hypercalcemia such as weakness, fatigue, headache, somnolence, vertigo, tinnitus, anorexia, nausea, vomiting, constipation, dry mouth, metallic taste, muscle pain, bone pain, ataxia, and hypotonia. Late symptoms may include polyuria, polydipsia, weight loss, nocturia, conjunctivitis, photophobia, rhinorrhea, pruritus, hyperthermia, decreased libido, and cardiac arrhythmias. Patients should also seek medical attention if they experience signs of digoxin toxicity such as nausea, anorexia, visual disturbances, slow pulse, or irregular heartbeats.

References

  1. "Product Information. Rocaltrol (calcitriol)." Roche Laboratories PROD (2001):
  2. "Product Information. Zemplar (paricalcitol)." Abbott Pharmaceutical PROD (2001):
  3. "Product Information. Hectorol (doxercalciferol)." Genzyme Corporation (2004):
  4. "Product Information. One-Alpha (alfacalcidol)." Pharmel Inc (2004):
  5. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  6. Therapeutic Research Faculty "Natural Medicines Comprehensive Database. http://www.naturaldatabase.com" (2008):
View all 6 references

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Drug and food interactions

Minor

digoxin food

Applies to: Lanoxin (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 "Nutrient-drug interactions." Adverse Drug React Toxicol Rev 14 (1995): 233-54
  2. Becquemont L, Verstuyft C, Kerb R, et al. "Effect of grapefruit juice on digoxin pharmacokinetics in humans." Clin Pharmacol Ther 70 (2001): 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

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