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Interacting Drugs

OBJECT DRUGS

PRECIPITANT DRUGS

P-glycoprotein Inhibitors:


Comment:

Inhibitors of P-glycoprotein reduce the renal and nonrenal elimination of digoxin. Digoxin plasma concentrations may increase two- to four-fold but larger increases may occur especially with potent P-glycoprotein inhibitors such as quinidine or amiodarone. Clarithromycin appears to cause greater increases in digoxin plasma concentrations than erythromycin or azithromycin. The mechanism for the substantial increase in digoxin concentrations following concurrent use of hydroxychloroquine is not established. Carvedilol (Coreg) may produce small increases in digoxin plasma concentrations, although larger increases have been reported in children. A metabolite of ezogabine inhibits P-glycoprotein and may increase plasma digoxin, but clinical reports are lacking.


Class 3: Assess Risk & Take Action if Necessary