Effect of sulfasalazine on digoxin bioavailability

Juhl, Randy P.; Summers, Robert W.; Guillory, J. Keith; Blaug, Seymour M.; Cheng, Frank H.F.; Brown, Donald J.

doi:10.1002/cpt1976204387

Cited by 52 publications

(17 citation statements)

References 16 publications

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“…This finding is consistent with the in vitro effects of tenidap on cytokine production: a correlation between CRP levels and IL-6 activity has been reported [6] and the cytokines, particularly IL-6, have been found to Correspondence: Dr P. E. Coates, Pfizer Central Research, Sandwich, Kent CT13 9NJ, UK mediate the release of acute phase proteins [7]. Tenidap 120 mg attains steady-state plasma concentration after 11 daily doses and is highly protein-bound [8].…”

Section: Introductionsupporting

confidence: 84%

“…Interactions between digoxin and currently available antirheumatic treatments have also been reported. The disease-modifying anti-rheumatic drug, cyclosporin, interacts with digoxin with a resultant increase in serum levels and enhanced toxicity [10], whereas sulphasalazine produces a decrease in serum digoxin of approximately 20% [11]. In ambulatory patients during the early stages of ibuprofen therapy, serum digoxin concentrations have been found to increase by more than 30% during the first 7 days of treatment [12].…”

Section: Discussionmentioning

confidence: 99%

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Effect of tenidap sodium on digoxin pharmacokinetics in healthy young men.

Pm¹,

Grimwood²,

Rapeport³

et al. 1995

Brit J Clinical Pharma

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1. The effects of tenidap sodium and placebo on digoxin pharmacokinetics were compared in 14 healthy young men, in a double-blind, parallel-group study lasting for 24 days. 2. Subjects were administered digoxin alone for the first 10 days and digoxin plus tenidap 120 mg day-1 or placebo for the remaining 14 days. 3. Changes in the means between day 10 (digoxin monotherapy) and day 24 (combined therapy) for renal clearance, area under the plasma concentration-time curve during the dosing interval, and the minimum and maximum plasma digoxin concentrations did not differ significantly between the tenidap and placebo groups. There was a small but statistically significant increase (0.5 h) in the time taken to reach maximum plasma digoxin concentration following 14 days' continuous tenidap co-administration compared with placebo, but this was not considered to be clinically meaningful. 4. Co-administration of tenidap and digoxin was well tolerated. No subject withdrew from the study during combination treatment. Treatment-related adverse events were of mild to moderate severity and were reported by four subjects on digoxin monotherapy, four on tenidap and digoxin, and by two on digoxin and placebo. Those reported by the tenidap group predominantly affected the gastrointestinal system and were mild in severity. There were no reports of laboratory test abnormalities or cardiovascular abnormalities related to combined digoxin and tenidap administration. 5. The results of this study indicate that, in healthy young men, co-administration of tenidap with digoxin does not have any apparent clinically significant effects on the pharmacokinetic profile of digoxin, and the treatment is well tolerated.

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Section: Introductionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Effect of tenidap sodium on digoxin pharmacokinetics in healthy young men.

Pm¹,

Grimwood²,

Rapeport³

et al. 1995

Brit J Clinical Pharma

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“…Of note is that the concentration of digoxin did not exceed 1 ng mL -1 while the symptoms subsided after the withdrawal of both drugs [52]. In cases of simultaneous administration of an oral form of digoxin and sulfasalazine, the concentration of the former can decrease even by 50%, depending on the dose of sulfasalazine [53]. In cases of concomitant use with salbutamol, the interaction is confirmed only when a betamimetic is taken orally in a dose of 3-4 mg.…”

Section: Digoxinmentioning

confidence: 98%

“…ciprofloxacin increases the concentration of theophylline by 17 to 113% [61,62]. The mechanism of this interaction involves strong inhibition of CYP1A2 metabolising theophylline [53]. The importance of this issue is evidenced by the fact that 39 cases of interactions of these drugs were reported to the Food and Drug Administration (FDA) in 1991; three cases were fatal [63].…”

Section: Theophyllinementioning

confidence: 99%

Farmakokinetyczne interakcje międzylekowe w oddziale intensywnej terapii – obserwacje jednoośrodkowe i przegląd piśmiennictwa

Łój¹,

Olender²,

Ślęzak³

et al. 2014

Anaesthesiol Intensive Ther

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Background: Drug-drug interactions constitute a serious health hazard in everyday clinical practice in critically ill patients. Drug-drug interactions may be pharmacokinetic or pharmacodynamic in their nature. We aimed to investigate the quantity and quality of possible drug-drug interactions, and their possible side effects in intensive care unit patients in a 12-month period. Methods: This retrospective study covered data on pharmacological treatment of 43 consecutive patients (11 females, 32 males) aged 62 ± 15 years, hospitalized between January 2015 and February 2016. Pharmacokinetic DDIs were identified and graded. Only severe and clinically important drug-drug interactions were subjected for further analysis. Results: Median baseline SAPS III was 53 (IQR 38-67) points. Median intensive care unit stay was 12 (6-25) days. Subjects were treated with a median number of 22 (12-27) drugs. We identified 27 (16-41) possible drug-drug interactions per patient, including 3 (1-7) drug-drug interactions of a severe grade. The total number of severe and clinically important drug-drug interactions was 253 of which 227 were analyzed in detail. No possible side-effects of drug-drug interactions were identified. Conclusions: DDIs as well as their side-effects are challenging regarding their precise evaluation, especially due to the need for multidrug treatment in critically ill patients. Concentration-controlled therapy should be recommended, especially for treatment with vancomycin, digoxin and valproate. Pantoprazole should be a proton pump-inhibitor of choice. Drug dose modification is necessary in combined treatment with fluconazole and amiodarone or rifampicin. From a clinical point of view, the most important impact of drug-drug interactions is on antibiotic treatment effectiveness, especially with meropenem when valproate is also prescribed.

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“…Antibiotic therapy may interfere with digoxin metabolism although exact mechanisms vary depending on the antibiotic [1][2][3][4][5][6]. We investigated whether antibiotics of the penicillin group given to elderly inpatients taking digoxin can alter digoxin concentrations or lead to digoxin toxicity.…”

mentioning

confidence: 99%