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A prospective study of the clarithromycin-digoxin interaction in elderly patients
1Department of Clinical Pharmacology, University General Hospital of Alicante, Maestro Alonso 109, 03010 Alicante, Spain. zapater_ped@gva.es
The Journal of Antimicrobial Chemotherapy
|October 3, 2002
Summary
Elderly patients taking digoxin experienced significantly higher drug levels when also treated with clarithromycin. This drug interaction, involving clarithromycin and digoxin, may be more common than previously thought.
Area of Science:
- Pharmacology
- Geriatric Medicine
- Drug Interactions
Background:
- Elderly patients often have chronic conditions requiring medications like digoxin.
- Potential drug interactions can significantly impact therapeutic outcomes and safety in this population.
Purpose of the Study:
- To evaluate the pharmacokinetic interaction between clarithromycin and digoxin in elderly individuals.
- To determine the effect of concomitant clarithromycin treatment on digoxin concentrations and pharmacokinetics.
Main Methods:
- Prospective observational trial design.
- Measurement of digoxin concentrations before and during clarithromycin co-administration.
- Utilized a Bayesian approach for pharmacokinetic analysis.
Main Results:
- A significant increase in digoxin concentration was observed after 4-7 days of clarithromycin treatment.
- Digoxin clearance decreased by 56-60%, and the elimination rate constant was reduced.
- Elimination half-life of digoxin increased by 82%.
Conclusions:
- A notable pharmacokinetic interaction exists between clarithromycin and digoxin in the elderly.
- This interaction leads to reduced digoxin clearance and prolonged half-life, increasing potential toxicity.
- The frequency of this clarithromycin-digoxin interaction may be underestimated.