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Lanoxin (Digoxin Tablets) and Zithromax Injection

Determining the interaction of Lanoxin (Digoxin Tablets) and Zithromax Injection and the possibility of their joint administration.

Check result:

Lanoxin (Digoxin Tablets) <> Zithromax Injection

Relevance: 05.07.2022 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 azithromycin. Combining these medications may 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: Macrolide antibiotics that inhibit P-glycoprotein may increase the plasma concentrations of digoxin. The proposed mechanism is 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, the majority of which involved clarithromycin, a potent P-glycoprotein inhibitor. Some patients have shown clinical signs consistent with digoxin toxicity, including potentially fatal arrhythmias. Exposure to macrolides, specifically clarithromycin, azithromycin and erythromycin, has been identified as a risk factor for digoxin toxicity. 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 (adjusted OR=3.71 and 3.69, respectively). Although little data exist, the interaction may also occur with digitoxin. Two cases of suspected azithromycin-induced digitoxin toxicity have been reported in the literature.

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

References

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Hughes J, Crowe A "Inhibition of P-glycoprotein-mediated efflux of digoxin and its metabolites by macrolide antibiotics." J Pharmacol Sci 113 (2010): 315-24
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Lanoxin (Digoxin Tablets)

Generic Name: digoxin

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

Synonyms: Lanoxin

What is Lanoxin (Digoxin Tablets)?

Zithromax Injection

Generic Name: azithromycin

Brand name: AzaSite, Azithromycin 3 Day Dose Pack, Azithromycin 5 Day Dose Pack, Zithromax, Zithromax Tri-Pak, Zithromax Z-Pak, Zmax, Zithromax IV

Synonyms: Azithromycin, Azithromycin (Systemic)

What is Zithromax Injection?

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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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