Propranolol Digoxin

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. 

Transfer to alternative agent (e.g., propranolol, digoxin, verapamil) Vi hr after first dose of alternative agent, reduce esmolol INF rate by 50% following second dose of alternative agent, monitor patient s response and, if satisfactory control is maintained for the first hr, discontinue esmolol INF... 

Supraventricular tachycardia is the major arrhythmia indication for verapamil. Adenosine or verapamil are preferred over older treatments (propranolol, digoxin, edrophonium, vasoconstrictor agents, and cardioversion) for termination. Verapamil can also reduce the ventricular rate in atrial fibrillation and flutter. It only rarely converts atrial flutter and fibrillation to sinus rhythm. Verapamil is occasionally useful in ventricular arrhythmias. However, intravenous verapamil in a patient with sustained ventricular tachycardia can cause hemodynamic collapse. 

Drug Interactions Gemfibrozil Niacin Erythromycin Cholestyramine Digoxin Cimetidine/ranitidine/ omeprazole Rifampicin Warfarin Itraconazole Gemfibrozil Niacin Erythromycin Propranolol Digoxin Warfarin Antacids Colestipol Digoxin Erythromycin Oral contraceptives Fibrates Niacin Azole antifungals... 

Enalapril, paracetamol, sotalol, dipyrone, vancomycin, captopril, fluconazole, cefazolin, metoprolol, aspirin, ticlopidine, prednisolone, propranolol, digoxin, sildenafil, furosemide, dexamethasone, carvedilol, ketoprofen, nifedipine, terbinafine, acenocoumarol, spironolactone/urine HPLC DAD Column LiChroCART Purospher STAR, RP-18e (250 x 4 mm, 5 pm) Mobile phase MeOH ACN 0.05 % TFA in water (gradient elution) Detection DAD X = 200 50 nm Adjusted to pH 7.0, protein precipitation LOD 0.01-1.44 pg/mL LOQ 0.04-4.35 pg/mL [72]... 

If symptomatic, either slow A-V conduction with Verapamil Propranolol Digoxin... 

The answer is a. (Katzung, p 240.) Older therapies—all designed to favor parasympathetic control of rhythm—include digoxin, propranolol, edrophonium, and vasoconstrictors. The vasoconstrictor phenylephrine (given by intravenous bolus) causes stimulation of the carotid sinus and reflex vagal stimulation of the atria. More recently, adenosine has been favored over verapamil, which is also very effective but slower acting... 

Fig. 4.3 CSF concentration/free (unbound) plasma concentration ratios for neutral and basic drugs 1, ritropirronium 2, atenolol 3, sulpiride 4, morphine 5, cimetidine 6, meto-prolol 7, atropine 8, tacrine 9, digoxin 10, propranolol 11, carbamazepine 12, ondansetron 13, diazepam 14, imipramine 15, digitonin 16, chlorpromazine and acidic drugs, a, salicylic acid b, ketoprofen c, oxyphenbutazone and d, indomethacin compared to log D.

Drugs that may affect miglitol include digestive enzymes and intestinal adsorbents. Drugs that may be affected by miglitol include digoxin, glyburide, metformin, propranolol, and ranitidine. 

Drugs that affect nefazodone include general anesthetics, sibutramine, sumatriptan, buspirone, carbamazepine, and propranolol. Drugs that may be affected by nefazodone include alcohol, benzodiazepines, buspirone, carbamazepine, cisapride, digoxin, haloperidol, HMG-CoA reductase inhibitors, MAOIs, propranolol, St. John s wort, cyclosporine, and tacrolimus. 

Flurazepam (Dalmane) [C-IV] [Sedative/Hypnotic/ Benzodiazepine] Uses Insomnia Action Benzodiazepine Dose Adults Beds >15 y. 15-30 mg PO qhs PRN X in elderly Caution [X, /-] Elderly, low albumin, hepatic impair Contra NAG PRG Disp Caps SE Hangover d/t accumulation of metabolites, apnea, anaphylaxis, angioedema, amnesia Interactions T CNS depression W/ antidepressants, antihistamines, opioids, EtOH T effects OF digoxin, phenytoin T effects W/ cimetidine, disulfiram, fluoxetine, iso-niazid, ketoconazole, metoprolol, OCPs, propranolol, SSRIs, valproic acid. 

Concurrent administration of propafenone with digoxin, warfarin, propranolol, or metoprolol increases the serum concentrations of the latter four drugs. Cimetidine slightly increases the propafenone serum concentrations. Additive pharmacological effects can occur when lidocaine, procainamide, and quinidine are combined with propafenone. 

Uses Type 2 DM Action a-Glucosidase inhibitor delays digestion of carbohydrates Dose Initial 25 mg PO rid maint 50-100 mg rid (w/ 1st bite of each meal) Caution [B, —] Contra DKA, obst/inflammatory GI disorders SCr >2 mg/dL Disp Tabs SE Flatulence, D, abd pain Interactions T Effects W/ celery, coriander, juniper berries, ginseng, garlic X- effects W/ENH, niacin, intestinal absorbents, amylase, pancreatin X- effects OF digoxin, propranolol, ranitidine EMS Can X- digoxin level-monitor ECG in pts on digoxin therapy OD May cause severe adverse GI Sxs symptomatic and supportive... 

Simvastatin (Zocor) [Anrilipemic/HMG-CoA Reductase Inhibitor] Uses X Cholesterol Action HMG-CoA reductase inhibitor Dose Adults. 5-80 mg PO w/ meals X in renal insuff Peds. 10-17 y 10 mg, 40 mg/daily max Caution [X, —] Avoid concurrent use of gemfibrozil Contra PRG, liver Dz Disp Tabs 5,10, 20, 40, 80 mg SE HA, GI upset, myalgia, myopathy (muscle pain, tenderness or weakness w/ creatine kinase 10 x ULN), Hep Interactions T Effects OF digoxin, warfarin T risk of myopathy/iiiabdomyolysis W/ amiodarone, cyclosporine, CYP3A4 inhibitors, fibrates, HIV protease inhibitors, macrolides, niacin, verapamil, grapefruit juice X effects W/ cholestyramine, colestipol, fluvas-tatin, isradipine, propranolol EMS T Effects of warfarin use amiodarone and... 

Amrinone lactate is physically and chemically incompatible with alkaline solutions. Pharmaceuticals that are incompatible include digoxin, potassium chloride, procainamide hydrochloride, propranolol hydrochloride, verapamil hydrochloride, sodium chloride, and glucose solutions containing frusemide.101... 

C.M. Riley, and P. Junkin, Stability of amrinone and digoxin, procainamide hydrochloride, propranolol hydrochloride, sodium bicarbonate, potassium chloride,... 

Lewis GP, Holtzman JL. Interaction of flecainide with digoxin and propranolol. Am J Cardiol 1984 53(5) B52-7. 

Cardiac dysrhythmias in digitalis overdose should be treated only if they are life-threatening. Phenytoin is probably the treatment of choice for ventricular tachydysrhyth-mias, but lidocaine or a beta-adrenoceptor antagonist, such as propranolol, are options. After an overdose of 300 tablets of digoxin (plasma digoxin concentration 50 ng/ml), recurrent ventricular fibrillation was successfully treated with bretylium tosylate (191). Sinus bradycardia may respond to atropine. 

Talley JD, Wathen MS, Hurst JW. Hyperthyroid-induced atrial flutter-fibrillation with profound sinoatrial nodal pauses due to small doses of digoxin, verapamil, and propranolol. Clin Cardiol 1989 12(l) 45-7. 

When salbutamol is used to arrest premature labor, effective doses are likely to produce mild fetal tachycardia (for example an increase of 20/minute) (23). In one case, supraventricular tachycardia occurred in the fetus in the 34th week of pregnancy after the mother had been treated with salbutamol digoxin with and without propranolol was ineffective, but amiodarone controlled the tachycardia (24). 

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