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Amoxicillin, clarithromycin, and lansoprazole and Digox Tablets

Determining the interaction of Amoxicillin, clarithromycin, and lansoprazole and Digox Tablets and the possibility of their joint administration.

Check result:

Amoxicillin, clarithromycin, and lansoprazole <> Digox Tablets

Relevance: 04.06.2022 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

Talk to your doctor before using digoxin together with clarithromycin. Combining these medications may significantly increase the blood levels and effects of digoxin. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. Contact your doctor if you experience nausea, vomiting, diarrhea, loss of appetite, visual disturbances (blurred vision; light halos around objects; green or yellow vision), or an abnormally fast or slow or uneven heartbeat, as these may be signs and symptoms of excessive digoxin levels. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Professional:

MONITOR CLOSELY: Coadministration with clarithromycin may significantly increase the plasma concentrations of digoxin. The proposed mechanism is clarithromycin inhibition of the P-glycoprotein-mediated intestinal efflux and/or renal tubular secretion of digoxin. The interaction has been described in numerous case reports in the medical literature. Some patients have shown clinical signs consistent with digoxin toxicity, including potentially fatal arrhythmias. Between 35% and greater than 2-fold increases in digoxin systemic exposure (AUC) have been reported in pharmacokinetic studies with clarithromycin, and exposure to clarithromycin has been identified as a risk factor for digoxin toxicity in several studies. A population-based, case-control study using records from Ontario, Canada's administrative health databases from 1994 to 2000 identified 1051 case patients who had been hospitalized with digoxin toxicity. These patients were about 12 times more likely to have received a prescription for clarithromycin in the previous week compared to controls without digoxin toxicity (n=51,896). Overall, 27 of the case patients (2.6%) had been exposed to clarithromycin within the previous week, compared to 101 controls (0.2%), which represented an adjusted odds ratio of 11.7. Fifty-five patients (5.2%) had been exposed to clarithromycin within the preceding 3 weeks, compared to 274 controls (0.5%), representing an adjusted OR of 8.5. A subsequent study using data from 1993 to 2008 from the same databases and focusing specifically on macrolide-induced digoxin toxicity found that the risk was significantly higher in patients who had received clarithromycin within the previous 2 weeks than in controls who did not receive antibiotics (adjusted OR=14.8). The risk of digoxin toxicity was 4 times higher following treatment with clarithromycin than with azithromycin or erythromycin. Another population-based study conducted by a group of investigators in Taiwan also reported a significantly higher risk of hospitalization for digoxin intoxication in heart failure patients who received clarithromycin, and that the risk could reach as high as 55.4-fold.

MANAGEMENT: Caution is advised if digoxin must be used in combination with clarithromycin. Serum digoxin levels and pharmacologic effects should be closely monitored and the dosage adjusted accordingly, particularly following initiation or discontinuation of clarithromycin in patients who are stabilized on their digitalis regimen. Patients should be advised to notify their physician if they experience signs of digoxin toxicity such as nausea, anorexia, visual disturbances, slow pulse, or irregular heartbeats.

References

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Amoxicillin, clarithromycin, and lansoprazole

Generic Name: amoxicillin / clarithromycin / lansoprazole

Brand name: Prevpac

Synonyms: Lansoprazole, Amoxicillin, and Clarithromycin

What is Amoxicillin, clarithromycin, and lansoprazole?

Digox Tablets

Generic Name: digoxin

Brand name: Digitek, Digox, Lanoxin, Lanoxicaps, Cardoxin

Synonyms: Digox (Oral)

What is Digox Tablets?

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In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.

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