Fluvastatin Digoxin

Absorption of certain drugs, including those with neutral or cationic charge as well as anions, may be impaired by the resins. These include digitalis glycosides, thiazides, warfarin, tetracycline, thyroxine, iron salts, pravastatin, fluvastatin, folic acid, phenylbutazone, aspirin, and ascorbic acid. Any additional medication (except niacin) should be given 1 hour before or at least 2 hours after the resin to ensure adequate absorption. Colesevelam does not bind digoxin, warfarin, or reductase inhibitors. 

A single dose of fluvastatin increased the steady-state Cmax of digoxin 0.125-0.5 mg/day by 11% and renal clearance by 15%, without changing AUC or fmax (8). 

Garnett WR, Venitz J, Wilkens RC, Dimenna G. Pharmacokinetic effects of fluvastatin in patients chronically receiving digoxin. Am J Med 1994 96(6A) S84-6. 

Clinically important, potentially hazardous interactions with alprazolam, aprepitant, astemizole, atorvastatin, benzodiazepines, carbamazepine, chlordiazepoxide, cilostazol, clonazepam, clorazepate, colchicine, conivaptan, cyclosporine, dabigatran, dasatinib, diazepam, digoxin, dihydroergotamine, disopyramide, ergot alkaloids, fesoterodine, fluoxetine, flurazepam, fluvastatin, HMG-CoA reductase inhibitors, imatinib, ixabepilone, lapatinib, lopinavir, lorazepam, lovastatin, methylprednisolone, methysergide, midazolam, nilotinib, oxazepam, paroxetine, pimozide, pravastatin, prednisone, quazepam, repaglinide, rimonabant, rivaroxaban, sertraline, silodosin, simvastatin, solifenacin, temazepam, temsirolimus, tolvaptan, trabectedin, triazolam, warfarin, zidovudine... 

Clinically important, potentially hazardous interactions with amiloride, aminoglycosides, amphotericin B, ampicillin, anisindione, anticoagulants, armodafinil, atorvastatin, azathioprine, azithromycin, bacampicillin, basiliximab, bezafibrate, bosentan, bupropion, carbenicillin, caspofungin, cholestyramine, clarithromycin, cloxacillin, co-trimoxazole, corticosteroids, cyclophosphamide, daclizumab, danazol, dicloxacillin, dicumarol, digoxin, diltiazem, disulfiram, echinacea, erythromycin, ethotoin, etoposide, ezetimibe, flunisolide, fluoxymesterone, fluvastatin, foscarnet, fosphenytoin, gemfibrozil, hemophilus B vaccine, HMG-CoA reductase inhibitors, imatinib, imipenem/cilastatin, influenza vaccines, ketoconazole, lanreotide, lopinavir, lovastatin, mephenytoin, methicillin, methoxsalen, methylphenidate, methylprednisolone, methyltestosterone, mezlocillin, mizolastine, mycophenolate, nafcillin, nisoldipine, NSAIDs, orlistat, oxacillin, penicillins, phellodendron, phenytoin, pravastatin, prednisolone, prednisone, pristinamycin, ranolazine, red rice yeast, rifabutin, rifampin, rifapentine, ritonavir, rosuvastatin, simvastatin, sirolimus, spironolactone, St John s wort, sulfacetamide, sulfadiazine, sulfamethoxazole, sulfisoxazole, sulfonamides, tacrolimus, telithromycin, tenoxicam, testosterone, ticarcillin, tolvaptan, trabectedin, triamterene, troleandomycin, ursodeoxycholic acid, vaccines, vecuronium, warfarin, zofenopril... 

Drugs digoxin, methotrexate (25 iM), ouabain, fluvastatin, rosuvastatin, rifampicin (2pM), bosentan, Ro 48-5033, Eluo-3 (6.8 pM)... 

OATP3Al vl, 710, 666 Drugs benzylpenicillin, digoxin, E-3-S, pravastatin, rosuvastatin fexofenadine, fluvastatin (1-3 pM/1), enalapril, temocaprilat, gadoxetate Other organic anions BSP (0.7 pM) Hormones and their conjugates T4, E-3-S Ubiquitous [6, 62, 63, 78]... 

Atorvastatin, fluvastatin and simvastatin cause small but probably clinically unimportant increases in the serum levels of digoxin. Pravastatin and rosuvastatin appear to have no effect on digoxin pharmacokinetics. 

In a crossover study in 18 patients, fluvastatin 40 mg caused no significant changes in the pharmacokinetics of digoxin 100 to 375 micrograms daily. Another similar study in patients found changes of up to 15% in maximum plasma digoxin levels and clearance, but these were not considered to be clinically relevant. ... 

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