Digoxin drug interactions with

Clinicians should be aware of a few drug interactions with Zolpidem. Flumazenil acts as an antagonist to the hypnotic effects of zolpidem. There is decreased alertness when zolpidem is combined with cimetidine. There is an increase in anterograde amnesia in volunteers treated with a combination of imipramine and zolpidem. Haloperidol, ranitidine, chlorpromazine, warfarin, and digoxin, along with cimetidine and flumazenil, do not alter the pharmacokinetics of zolpidem (Salva and Costa, 1995). 

Drugs interacting with digoxin and other digitalis glycosides. 

Drug interactions with cardiac glycosides can be subdivided into six types, according to mechanism. Interactions with digoxin have been reviewed (SEDA-6, 173) (196-198). Drug interactions with digitoxin have been briefly reviewed in the context of its use in the treatment of congestive heart failure (199). 

Brown DD, Spector R, Juhl RP. Drug interactions with digoxin. Drugs 1980 20(3) 198-206. 

Antman EM, Arnold M, Friedman PL, White H, Bosak M, Smith TW. Drug interactions with cardiac glycosides evaluation of a possible digoxin-ethmozine pharmacokinetic interaction. J Cardiovasc Pharmacol 1987 9(5) 622-7. 

Drug interactions with hawthorn are theoretically possible with cardioactive medications, but have not been documented (2). In addition, the flavonoid constituents have been shown to have inhibitory and inducible effects on the cytochrome P-450 enzyme system, making other drug interactions possible (20). However, an in vivo study of a potential pharmacokinetic interaction of digoxin and hawthorn demonstrated that concurrent administration had no effect on digoxin pharmacokinetics, suggesting that the two could be safely administered together from a pharmacokinetic point of view (21). However, one must be mindful of additive effects and a potential pharmacodynamic interaction. 

Drug interactions with omeprazole are of particular concern in patients who are considered slow metabolizers, as found in approximately 3% of the Caucasian population. Unfortunately, it is unclear which patients have the polymorphic gene variation that makes them slow metabolizers. Like omeprazole, the metabolism of esomeprazole may also be altered in patients with this polymorphic gene variation. Rabeprazole increases digoxin trough concentrations by approximately 20%. Patients on potentially interacting drugs should be monitored closely for potential problems. 

Cautions Autoimmune disease (methyldopa) Orthostatic hypotension Allergy, bradyarrhythmias, coronary spasm, PVD Diabetes mellitus, digitalis toxicity, gout, hyperlipidemias Renal insufficiency, autoimmune diseases, drug interactions with diuretics, digoxin, Li Guanethidine asthma, GI ulcers, renal dysfunction Potent vasodilators > major compensatory fluid retention and cardiac stimulation... 

Rodin, S. M., and Johnson, B. F. (1988). Pharmacokinetic drug interactions with digoxin. Clin. Pharmacokinet. 15, 227-244. 

Drug interactions with orally administered drugs (warfarin, thiazides, digoxin, etc.)... 

A) A possible drug interaction with digoxin suggests that digoxin blood levels should be obtained before and after starting procainamide... 

Only a small number of drug interactions have been reported with donepezil. In vitro studies show a low rate of binding of donepezil to cytochrome P-450 (CYP)3A4 or 2D6. Whether or not donepezil has the potential for enzyme induction is not known. No interactions with theophylline, cimeti-dine, warfarin, digoxin, or ketoconazole have been documented. In vitro studies show that inhibitors of CYP3A4 and 2D6 have the potential to inhibit the metabolism of donepezil. The clinical relevance of this is unknown. However, monitoring for possible increased peripheral side effects is advised... 

Although many patients believe that dietary supplements will not interact with medications, recent literature suggests otherwise. Recently, many St. John s wort-drug interactions have been reported in the literature. Cases of patients developing symptoms of serotonin syndrome have been reported with St. John s wort alone and in concomitant therapy with other antidepressants such as monoamine oxidase inhibitors, serotonin reuptake inhibitors, and venlafaxine. St. John s wort may exacerbate the sedative effects of benzodiazepines, alcohol, narcotics, and other sedatives. St. John s wort may decrease the levels of protease inhibitors, cyclosporine, digoxin, and theophylline. 

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