Drug General Information (ID: DDI169J7ZK)
Drug Name			Ramipril		Drug Info		Digoxin		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antihypertensive Agents				Antiarrhythmic Agents
Structure

Mechanism of Ramipril-Digoxin Interaction (Severity Level: Moderate)
Decreased renal excretion (Unspecific) Click to Show/Hide Mechanism Graph
Drug Name		Ramipril				Digoxin
Mechanism		Reduce tubular secretion of digoxin				Digoxin
Key Mechanism Factor 1
		Factor Name		Pharmacokinetics
		Factor Description		Alters the excretion of the drug, resulting in changes in the plasma concentration of the drug and affecting the pharmacological effects.
Mechanism Description		Decreased renal excretion of Digoxin caused by Ramipril

Recommended Action
Management		While this combination has demonstrated benefits in some CHF patients, their clinical response and digoxin levels should be monitored. Patients should be advised to notify their physician if they experience nausea, anorexia, visual disturbances, slow pulse, or irregular heartbeats.

References
1	Agencia Espaola de Medicamentos y Productos Sanitarios Healthcare "Centro de informacion online de medicamentos de la AEMPS - CIMA.".
2	Cleland JG, Dargie HJ, Pettigrew A, Gillen G, Robertson JI "The effects of captopril on serum digoxin and urinary urea and digoxin clearances in patients with congestive heart failure." Am Heart J 112 (1986): 130-5. [PMID: 3524169]
3	Doering W, Maass L, Irmisch R, Konig E "Pharmacokinetic interaction study with ramipril and digoxin in healthy volunteers." Am J Cardiol 59 (1987): d60-4. [PMID: 3034035]
4	Douste-Blazy P, Blanc M, Montastruc JL, et al "Is there any interaction between digoxin and enalapril?" Br J Clin Pharmacol 22 (1986): 752-3. [PMID: 3032228]
5	Kromer EP, Elsner D, Riegger GA "Digoxin, converting-enzyme inhibition (quinapril), and the combination in patients with congestive heart failure functional class II and sinus rhythm." J Cardiovasc Pharmacol 16 (1990): 9-14. [PMID: 1696671]
6	Miyakawa T, Shionoiri H, Takasaki I, et al "The effect of captopril on pharmacokinetics of digoxin in patients with mild congestive heart failure." J Cardiovasc Pharmacol 17 (1991): 576-80. [PMID: 1711623]
7	Rodin SM, Johnson BF "Pharmacokinetic interactions with digoxin." Clin Pharmacokinet 15 (1988): 227-44. [PMID: 3056649]