Statins Digoxin

Substrates MTX, thyroxines, digoxin (Oatp2), bile salts, peptides, eicosanoids, statins, GSH, glucuronide and sulfate conjugates of hormones... 

DIGOXIN STATINS High-dose (80 mg) atorvastatin may t digoxin levels Atorvastatin inhibits intestinal P-gp, which t absorption of digoxin Watch for digoxin toxicity... 

The effects of statins on the pharmacokinetics of digoxin have been variable. There is no simple explanation that reconciles the disparate findings. 

Telithromycin has several clinically significant drug interactions similar to those for erythromycin. It is both a substrate and a strong inhibitor of CYP3A4. Coadministration of rifampin, a potent inducer of CYP, decreases the serum concentrations of telithromycin by 80%. CYP3A4 inhibitors (e.g., itraconazole) increase peak serum concentrations of telithromycin. Serum concentrations of CYP3A4 substrates (e.g., pimozide, cisapride, midazolam, statins, cyclosporine, phenytoin) are increased by telithromycin. Telithromycin also increases peak serum concentrations of metoprolol and digoxin. 

The small changes seen in digoxin levels are probably due to the inhibitory effects of these statins on P-glycoprotein. Ptavastatin does not appear to inhibit P-glycoprotein. ... 

The small changes seen in the digoxin levels with statins seem unlikely to be clinically relevant in most patients. 

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