Ciclosporin Digoxin

Concentration dependent toxicity Aminoglycosides Cytotoxic agents Ciclosporin Digoxin Lithium Tacrolimus Theophylline Warfarin... 

Interactions of St. John s wort with prescribed drugs are due to its ability to induce the activity of both CYP3A4 and the P glycoprotein transporter system (16). Prescribed drugs that interact with St. John s wort include ciclosporin, digoxin, HIV protease inhibitors, oral contraceptives, serotonin re-uptake inhibitors, theophyUine, and warfarin (17). 

The concurrent use of ranolazine and moderate or potent inhibitors of CYP3A4, such as some azoles, diltiazem, grapefruit juice, macrolides, protease inhibitors, or verapamil will result in increased levels of ranolazine, and can predispose the patient to adverse effects including QT interval prolongation. Cimetidine and paroxetine do not interact to a clinically significant extent. Ranolazine may increase levels of ciclosporin, digoxin or simvastatin. 

The absorption of some drugs may also be reduced if they are given with adsorbents such as charcoal or kaolin, or anionic exchange resins such as colestyramine or colestipol. The absorption of propranolol, digoxin, warfarin, tricyclic antidepressants, ciclosporin and levothyroxine is reduced by colestyramine. 

DIGOXIN CICLOSPORIN t plasma digoxin levels, with risk of toxicity. Digoxin may t cidosporin bioavailability (by 15-20%) Attributed to inhibition of intestinal P-gp and renal P-gp, which t bioavailability and t renal elimination. Digoxin t bioavailability of cidosporin due to substrate competition for P-gp Watch for digoxin toxicity. Monitor plasma digoxin and cidosporin levels... 

Drugs that are known to be substrates of P-gp include antihistamines (e.g. terfenadine), digoxin, ciclosporin, hydrocortisone and other steroids and drugs used in chemotherapy (e.g. paclitaxel, vinblastine). Ciclosporin, in addition to being a substrate of P-gp, is also an inhibitor of P-gp. Drugs known to induce P-gp include morphine, dexamethasone, phenobarbital, rifampin and St John s wort. Inhibitors of P-gp include amiodarone, amitriptyline, atorvastatin, chlorpromazine, ciclosporin, erythromycin, fluphenazine, haloperidol, quinidine, ritonavir and verapamil,... 

A 52-year-old man developed rhabdomyolysis while taking simvastatin, digoxin, ciclosporin, and verapamil (298). The authors proposed that this had been due in part to inhibition of the biliary secretion of simvastatin by digoxin however, it is likely that the major mechanism of the interaction was inhibition of CYP3A4 by ciclosporin. 

In an analysis of changes in ciclosporin clearance and systemic availability obtained from the medical records of 100 transplant patients, digoxin increased ciclosporin systemic availability (228). 

Single-dose ciclosporin slightly increased the absorption of sitagliptin, although this was not considered clinically relevant. Sitagliptin does not have a clinically relevant effect on the pharmacokinetics of digoxin, oral contraceptives, simvastatin or warfarin. 

Ciclosporin causes a marked rise in serum digoxin levels in some patients. 

Not fully understood. The authors of the studies concluded that ciclosporin has no specific inhibitory effect on the renal elimination of digoxin, but that it causes a non-specific reduction in renal function after acute administration, which reduces digoxin elimination. Conversely, another study in animals suggested that ciclosporin can reduce the secretion of digoxin by the kidney tubular cells by inhibiting P-glycoprotein. ... 

Caution is recommended when eplerenone is used with alpha blockers, antipsychotics, amifostine, baclofen, corticosteroids, tetracosactide and tricyclic antidepressants. Lithium, ciclosporin, and tacrolimus should generally not be used with eplerenone. Antacids, cisapride, midazolam and simvastatin had no effect on eplerenone pharmacokinetics. Eplerenone had no important effect on cisapride, midazolam, warfarin or contraceptive steroid pharmacokinetics, but caused a slight increase in digoxin levels. 

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