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Digoxin-trimethoprim interaction.

P Petersen, J Kastrup, R Bartram

    Acta Medica Scandinavica
    |January 1, 1985
    PubMed
    Summary
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    Trimethoprim increases serum digoxin levels in elderly patients by reducing renal clearance. This interaction is primarily due to decreased renal tubular secretion, not altered extrarenal clearance.

    Area of Science:

    • Pharmacology
    • Geriatric Medicine
    • Clinical Pharmacy

    Background:

    • Digoxin is a crucial medication for heart failure and arrhythmias.
    • Elderly patients often have altered drug metabolism and excretion.
    • Potential drug interactions involving digoxin require careful evaluation, especially in geriatric populations.

    Purpose of the Study:

    • To investigate the effect of trimethoprim on serum digoxin levels in elderly patients.
    • To elucidate the pharmacokinetic changes of digoxin induced by trimethoprim in healthy subjects.

    Main Methods:

    • Observational study in nine elderly patients on stable digoxin dosage.
    • Pharmacokinetic analysis in six healthy subjects receiving intravenous digoxin with and without trimethoprim.
    • Measurement of serum digoxin, renal clearance, and extrarenal clearance.

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    Main Results:

    • Serum digoxin levels increased by 22% in elderly patients during trimethoprim treatment (p < 0.05).
    • In healthy subjects, trimethoprim decreased renal clearance of digoxin by 17% (p < 0.05) but did not affect total body clearance.
    • Extrarenal clearance, biological half-life, and compartment volumes of digoxin remained unchanged.

    Conclusions:

    • Trimethoprim significantly increases serum digoxin concentrations in the elderly.
    • The interaction is attributed to reduced renal tubular secretion of digoxin by trimethoprim.
    • This finding highlights the importance of monitoring digoxin levels when co-administered with trimethoprim, particularly in older adults.