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Related Experiment Videos

Digoxin toxicity secondary to clarithromycin therapy

J J Nawarskas1, D M McCarthy, S A Spinler

  • 1Philadelphia College of Pharmacy and Science, PA 19104, USA.

The Annals of Pharmacotherapy
|July 1, 1997
PubMed
Summary

Clarithromycin can cause digoxin toxicity by altering gut bacteria that metabolize digoxin, increasing its absorption. Patients taking digoxin should have levels monitored when starting clarithromycin.

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Area of Science:

  • Pharmacology
  • Internal Medicine
  • Cardiology

Background:

  • Digoxin is a common medication for heart failure.
  • Clarithromycin is a widely used antibiotic.
  • Drug interactions can significantly impact patient safety and treatment efficacy.

Observation:

  • A patient on digoxin developed toxicity after starting clarithromycin.
  • High serum digoxin concentration (4.4 mug/L) and ECG changes were noted.
  • Symptoms resolved after discontinuing clarithromycin and digoxin.

Findings:

  • This is the fourth reported case of digoxin toxicity linked to clarithromycin.
  • The interaction is likely due to clarithromycin affecting gut flora that metabolize digoxin, increasing its bioavailability.
  • Patients with extensive presystemic digoxin metabolism may be more susceptible.

Implications:

  • Healthcare providers should be aware of this potential drug interaction.
  • Monitoring serum digoxin levels during clarithromycin therapy is recommended for susceptible patients.
  • This interaction underscores the importance of medication reconciliation and pharmacovigilance.

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