Proton pump inhibitors 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. 

Proton pump inhibitors cause a profound and long-lasting inhibition of gastric acid secretion therefore, proton pump inhibitors may interfere with the absorption of drugs where gastric pH is an important determinant of bioavailability (eg, ketoconazole, ampicillin, iron salts, digoxin, cyanocobalamin). 

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... 

Itraconazole has significant interactions with a number of commonly prescribed drugs, such as rifampin, phenytoin, and carbamazepine. Itraconazole raises serum digoxin and cyclosporine levels and may affect the metabolism of oral hypoglycemic agents and coumadin. Absorption of itraconazole is impaired by antacids, Hj blockers, proton pump inhibitors, and drugs that contain buffers, such as the antiretroviral agent didanosine. 

DIGOXIN PROTON PUMP INHIBITORS Plasma concentrations of digoxin are possibly t by proton pump inhibitors Small t in bioavailability possible via t intragastric pH or altered intestinal P-gp transport Not thought to be clinically significant unless a poor CYP2C19 metabolizer. No specific recommendations. Different proton pump inhibitors may interaction differently - monitor if changing therapy or doses... 

Recognition of the mechanism of acid secretion then led to the development of a new class of antiulcer drugs, the substituted pyridyl methylsulfinyl benzimidazoles, one of which is shown in the figure above. These are now the mainstay for treatment of most add related diseases. Both the sodium pump and the acid pump remain specific drug targets, digoxin for the former, proton pump inhibitors for the latter. 

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