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Digoxin and Neoral

Determining the interaction of Digoxin and Neoral and the possibility of their joint administration.

Check result:

Digoxin <> Neoral

Relevance: 18.05.2023 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:

Using digoxin together with cycloSPORINE may increase the effects of digoxin. Contact your doctor if you experience nausea, vomiting, decreased appetite, diarrhea, confusion, seizures, hallucinations, light "halos" around objects, green or yellow vision, fatigue, irregular heartbeats, and abnormally fast or slow heartbeats. If your doctor prescribes these medications together, you may need a dose adjustment or special test to safely use both medications. 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: Cyclosporine may increase both serum levels and pharmacologic effects of digoxin. The mechanism is unknown, but may be related to inhibition of P-glycoprotein-mediated renal tubular secretion by cyclosporine. Based on limited clinical findings, a 4-fold increase in digoxin levels and a 47% to 58% reduction in digoxin clearance have been reported following concomitant administration with cyclosporine.

MANAGEMENT: If these drugs must be used together, the patient should be closely monitored for evidence of digoxin toxicity. The need to readjust digoxin dosage after cardiac transplantation should be expected. Patients should be advised to notify their physicians if they experience signs of possible digoxin toxicity or electrolyte disturbances, such as weakness, lethargy, muscle pains or cramps, nausea, anorexia, visual changes, or irregular heartbeats.

References

Balayssac D, Authier N, Cayre A, Coudore F "Does inhibition of P-glycoprotein lead to drug-drug interactions?" Toxicol Lett 156 (2005): 319-29
De Lannoy IA, Koren G, Klein J, et al "Cyclosporin and quinidine inhibition of renal digoxin excretion: evidence for luminal secretion of digoxin." Am J Physiol 263 (1992): f613-22
Drescher S, Glaeser H, Murdter T, Hitzl M, Eichelbaum M, Fromm MF "P-glycoprotein-mediated intestinal and biliary digoxin transport in humans." Clin Pharmacol Ther 73 (2003): 223-31
Robieux I, Dorian P, Klein J, Chung D, Zborowska-Sluis D, Ogilvie R, Koren G "The effects of cardiac transplantation and cyclosporine therapy on digoxin pharmacokinetics." J Clin Pharmacol 32 (1992): 338-43
Dorian P, Cardella C, Strauss M, et al "Cyclosporine nephrotoxicity and cyclosporine-digoxin interaction prior to heart transplantation." Transplant Proc 19 (1987): 1825-7
Tanigawara Y, Okamura N, Hirai M, et al "Transport of digoxin by human P-glycoprotein expressed in a porcine kidney epithelial cell line (LLC-PK1)." J Pharmacol Exp Ther 263 (1992): 840-5
Dorian P, Strauss M, Cardella C, et al "Digoxin-cyclosporine interaction: severe digitalis toxicity after cyclosporine treatment." Clin Invest Med 11 (1988): 108-12
Cerner Multum, Inc. "Australian Product Information." O 0
Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0

Digoxin

Generic Name: digoxin

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

Synonyms: n.a.

What is Digoxin?

Neoral

Generic Name: cyclosporine

Brand name: Gengraf, Neoral, Sandimmune, Sandimmune

Synonyms: Neoral (Capsules, Modified)

What is Neoral?

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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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