Clarithromycin Digoxin

Drugs that may be affected by proton pump inhibitors include azole antifungal agents (eg, itraconazole, ketoconazole), benzodiazepines, cilostazol, clarithromycin, digoxin, phenytoin, salicylates, sulfonylureas, and warfarin. Drugs that may affect proton pump inhibitors include sucralfate and clarithromycin. 

Juurlink DN. Ito S. Comment clarithromycin-digoxin interaction. Ann Pharmacother 1999 33(12) 1375-6. 

Clinically important, potentially hazardous interactions with clarithromycin, digoxin, indinavir, itraconazole, ketoconazole, ritonavir... 

Zapater P, Reus S, Tello A Tomls D, P rez-Mateo M, Horga JF. A prospective study of the clarithromycin-digoxin interaction in elderly patients. J Antimicrob Chemo er (2002) 50,... 

Chan AL, Wang MT, Su CY, Tsai FH. Risk of digoxin intoxication caused by clarithromycin-digoxin interactions in heart failure patients a population-based study. Eur J Clin Pharmacol 2009 65(12) 1237 3. 

Drugs that may affect disopyramide include antiarrhythmics, beta blockers, cisapride, clarithromycin, erythromycin, fluoroquinolones, hydantoins, quinidine, thioridazine, rifampin, verapamil, and ziprasidone. Drugs that may be affected by disopyramide include quinidine, anticoagulants, and digoxin. 

Clarithromycin Drugs that may be affected by clarithromycin include anticoagulants, benzodiazepines, buspirone, carbamazepine, cisapride, cyclosporine, digoxin. 

PO H. pylori Infxn 40 mg/d PO, plus clarithromycin 500 mg PO bid amoxicillin 1000 mg bid for 10 d Caution [B, /-] Contra Component sensitivity Disp Caps, IV SE HA, D, abd pain Interactions t Effects W7 amoxicillin, clarithromycin T effects OF benzodiaz ines, warfarin X effects OF digoxin, keto-conazole, iron salts EMS Use caution w/ diazepam, may t risk of diazepam tox OD May cause sweating, blurred vision, tach, and confusion symptomatic and supportive... 

Estazolam (Prosom) [C-IV] [Hypnotic/Benzodiazepine] Uses Short-term management of insomnia Action Benzodiazepine Dose 1-2 mg PO qhs PRN -1- in hqjatic impair/elderly/debilitated Caution [X, -] t Effects w/ CNS d ressants Contra PRG Disp Tabs SE Somnolence, weakness, palpitations, anaphylaxis, angioedema, amnesia Interactions t Effects W7 amoxicillin, clarithromycin T effects OF diaz am, phen5rtoin, warfarin X effects W7 food X effects OF azole antifungals, digoxin EMS Use caution w/ other benzodiazepines, may need a reduced dose concurrent EtOH and caffeine use can t CNS effects OD May cause alt ed reflexes, drowsiness, CNS depression, slurred speech, and Szs flumazenU can be used as an antidote... 

Rabeprazole (AcipHex) [Antiulcer Agent/Proton Pump Inhibitor] Uses PUD, GERD, ZE H. pylori Action Proton pump inhibitor Dose 20 mg/d may T to 60 mg/d H. pylori 20 mg PO bid X 7 d (w/ amoxicillin and clarithromycin) do not crush/chew tabs Caution [B, /—] Disp Tabs SE HA, fatigue, GI upset Interactions t Effects OF cyclosporine, digoxin -1- effects OF ketoconazole EMS None OD May cause N, tach, dry mouth, and drowsiness symptomatic and supportive... 

The ratio of renal clearance of digoxin to creatinine clearance decreased with the coadministration of clarithromycin (0.64 and 0.73), and was restored (1.30) after administration of clarithromycin had stopped (326). The role of P-gp efflux in this interaction was confirmed using an in vitro kidney epithelial cell line (326). The administration of itraconazole, a P-gp inhibitor, with digoxin resulted in an increased trough concentration and a decrease in the amount of renal clearance, possibly by an inhibition of the renal tubular secretion of digoxin via P-gp (329). The P-gp modulator verapamil has also been shown to decrease the renal clearance of digoxin (330). 

Wakasugi H, Yano I, Ito T, et al. Effect of clarithromycin on renal excretion of digoxin interaction with P-glycoprotein. Clin Pharmacol Ther 1998 64(1) 123—128. 

Interactions Erythromycin and clarithromycin inhibit the hepatic metabolism of theophylline, warfarin, terfenadine, astemizole, carbamazepine and cyclosporine which can lead to toxic accumulations of these drugs. An interaction with digoxin may occur in some patients. In this case, the antibiotic eliminates a species of intestinal flora that ordinarily inactivates digoxin, thus leading to greater reabsorption of digoxin from the enterohepatic circulation. 

As in the liver, drugs that undergo renal P-gp transport are susceptible to interactions resulting from modulation of P-gp- Inhibition of renal P-gp may lead to the development of unexpected toxicities or improved clinical efficacy secondary to increased drug exposure. Clarithromycin was found to increase the bioavailability of and reduce the renal clearance of digoxin in a group of healthy volunteers, resulting... 

Trivedi S, Hyman J, Lichstein E. Clarithromycin and digoxin toxicity [letter]. Ann Intern Med 1998 128 604. 

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