Digoxin Acarbose

Rosiglitazone has been studied in combination with acarbose, digoxin, metformin, nifedipine, ranitidine, warfarin, and oral contraceptives [67,72] There have been no clinically significant effects on the pharmacokinetics of any of these agents in combination with rosiglitazone. 

Drugs that may interact with acarbose include digestive enzymes, intestinal adsorbents (eg, charcoal) and digoxin. 

Acarbose can reduce plasma concentrations of digoxin by impairing its absorption (70). 

A 69-year-old woman with diabetes mellitus and heart failure repeatedly had unusual subtherapeutic plasma digoxin concentrations (72). When acarbose was withdrawn the plasma digoxin concentration rose. 

In a randomized, crossover study in healthy men, acarbose 100-200 mg reduced the AUC and Cmax of digoxin and prolonged its tmax, consistent with reduced absorption (73). However, in another study acarbose 50 mg tds for 12 days had no significant effect on the pharmacokinetics of a single oral dose of digoxin 0.75 mg (74). 

Ben-Ami H, Krivoy N, Nagachandran P, Roguin A, Edoute Y. An interaction between digoxin and acarbose. Diabetes Care 1999 22(5) 860-1. 

Nagai Y, Hayakawa T, Abe T, Nomura G. Are there different effects of acarbose and voglibose on serum levels of digoxin in a diabetic patient with congestive heart failure Diabetes Care 2000 23(11) 1703. 

Serrano JS, Jimenez CM, Serrano MI, Balboa B. A possible interaction of potential clinical interest between digoxin and acarbose. Clin Pharmacol Ther 1996 60(5) 589-92. 

Miura T, Ueno K, Tanaka K, Sugiura Y, Mizutani M, Takatsu F, Takano Y, Shibakawa M. Impairment of absorption of digoxin by acarbose. J Clin Pharmacol 1998 38(7) 654-7. 

Cohen E, Almog S, Staruvin D, Garty M. Do therapeutic doses of acarbose alter the pharmacokinetics of digoxin Isr Med Assoc J 2002 4(10) 772-5. 

Neomycin Neomycin interferes with the absorption of digoxin, methotrexate, vitamins, some penicillins, acarbose, and oral contraceptives. 

DIGOXIN ANTIDIABETIC DRUGS-ACARBOSE Acarbose may 1 plasma levels of digoxin Uncertain possibly 1 absorption of digoxin Monitor digoxin levels watch for 1 levels... 

The gastrointestinal tract is the main site of action of acarbose, which is metabolized exclusively within the gastrointestinal tract, principally by intestinal bacteria this process may be adversely affected by antibiotics that alter the intestinal bacterial flora. Acarbose affects the absorption of some drugs (e.g. digoxin). 

However, in a formal study of the pharmacokinetics of a single dose of digoxin 0.75 mg before and after the administration of acarbose 50 mg tds for 12 days in healthy volunteers, apart from a small increase in Cmax, the pharmacokinetics of digoxin were unaffected by acarbose (219). It is not uncommon for anecdotal reports of a possible interaction to be unconfirmed by formal kinetic studies, and it is possible in such cases that there is a subset of patients who are susceptible to the interaction who have not been included in the formal study. In this case, for example, it may be that the interaction occurs in people with diabetes and not in healthy subjects. There may also be a difference in the effect of acarbose on a single dose of digoxin, compared with steady-state therapy. Advice that acarbose and digoxin should be administered 6 hours apart is still reasonable. 

HiUebrand I, Graefe KH, Bischoff H, Frank G, Raemsch KD, Berchtold P. Serum digoxin-andpropranolol levels during acarbose treatment. Diabetologia (1981) 21,282-3. 

Some but not all studies have found that digoxin plasma levels can be markedly reduced by acarbose. Miglitol modestly reduced digoxin levels in healthy subjects, but no change was seen in diabetic patients. Voglibose does not appear to interact adversely with digoxin. 

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