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Related Experiment Videos

Lethal quercetin-digoxin interaction in pigs.

Yao-Horng Wang1, Pei-Dawn L Chao, Su Lan Hsiu

  • 1Institute of Pharmaceutical Chemistry, China Medical University, Taichung, Taiwan.

Life Sciences
|December 31, 2003
PubMed
Summary

Quercetin significantly increases digoxin levels, potentially causing toxicity. Avoid combining digoxin with quercetin or quercetin-rich supplements due to serious pharmacokinetic interactions and adverse events, including fatalities.

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Area of Science:

  • Pharmacology
  • Toxicology
  • Drug Interactions

Background:

  • Digoxin, a narrow therapeutic index cardiac glycoside, is a substrate for P-glycoprotein (P-gp).
  • Quercetin, a common antioxidant flavonoid, is known to modulate P-gp activity.
  • Potential interactions between digoxin and quercetin warrant investigation due to P-gp involvement.

Purpose of the Study:

  • To investigate the pharmacokinetic interaction between quercetin and digoxin following oral administration in a porcine model.
  • To assess the impact of quercetin on the absorption and disposition of digoxin.

Main Methods:

  • A crossover study design was employed in pigs.
  • Pigs received oral digoxin (0.02 mg/kg) with and without varying doses of quercetin.
  • Serum digoxin concentrations were measured using fluorescence polarization immunoassay.

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  • Pharmacokinetic parameters were calculated using WINNONLIN software.

    • Main Results:

    • Coadministration of 50 mg/kg quercetin led to sudden death in two of three pigs within 30 minutes.
    • A 40 mg/kg quercetin dose significantly increased digoxin's Cmax by 413% and AUC0-t by 170%.
    • These findings indicate a severe pharmacokinetic interaction between quercetin and digoxin.

    Conclusions:

    • Concomitant administration of digoxin and quercetin results in a significant and potentially dangerous pharmacokinetic interaction.
    • The use of quercetin or quercetin-containing products alongside digoxin should be strictly avoided.
    • Clinicians and patients should be aware of this interaction to prevent adverse events.