Penicillamine Digoxin

Penicillamine Digoxin 1 Digoxin serum may be reduced, possibly decreasing its pharmacological effects. The digoxin dose may need to be increased. 

There is an increased risk of toxicity of MTX when administered with the NSAIDs, salicylates, oral antidiabetic drugs, phenytoin, tetracycline, and probenecid. There is an additive bone marrow depressant effect when administered with other drug known to depress the bone marrow or with radiation therapy. There is an increased risk for nephrotoxicity when MTX is administered with other drug that cause nephrotoxicity. When penicillamine is administered with digoxin, decreased blood levels of digoxin may occur. There is a decreased absorption of penicillamine when the dmg is administered with food, iron preparations, and antacids. 

Drugs that may be affected by penicillamine include digoxin. 

Drugs that may be affected by NSAIDs include the following Aminoglycosides, anticoagulants, ACE inhibitors, beta blockers, cyclosporine, dextromethorphan, digoxin, dipyridamole, hydantoins, lithium, loop diuretics, methotrexate, penicillamine, potassium-sparing diuretics, sympathomimetics, theophylline, thiazide diuretics. 

Aminoquinolines can increase plasma concentrations of penicillamine, hence the potential for serious hematological or renal toxicity. Similarly, aminoquinolines can increase digoxin levels. Gold and an amino-quinoline probably should not be administered concurrently because of the propensity of each to produce dermatitis. 

DIGOXIN PENICILLAMINE Plasma concentrations of digoxin may be l by penicillamine Uncertain at present Watch for poor response to digoxin... 

Noninterfering diazepam, digoxin, methylprednisolone, midazolam, nifedipine, penicillamine, ranitidine, theophylline... 

In 10 patients, penicillamine 1 g daily taken 2 hours after an oral dose of digoxin, reduced the serum digoxin levels measured 2,4 and 6 hours later, by 13%, 20% and 39%, respectively. In 10 other patients similarly treated but given digoxin intravenously, the serum digoxin levels measured 4 and 6 hours later were reduced by 23% and 64%, respectively. The same authors have also reported this interaction in children. ... 

Information seems to be limited to the reports cited. Patients taking digoxin should be checked for signs of under-digitalisation if penicillamine is added. Information about digitoxin appears to be lacking. 

Moezzi B, Fatourechi V, Khozain R, Eslami B. The effect of penicillamine on serum digoxin levels. JjpwifeartJ (1978) 19, 366-70. 

MoezziB,KhozeinR,PooymehrF, Shakibi JG. Reversal of digoxin-induced changes in erythrocyte electrolyte concentrations by penicillamine in children. (1980) 21, 335-9. 

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