Details of Drug Interaction

Details of Drug-Drug Interaction

 Drug General Information (ID: DDI1EKT3MO)
  Drug Name Digoxin Drug Info Cholestyramine Drug Info
  Drug Type Small molecule Small molecule
  Therapeutic Class Antiarrhythmic Agents Bile Acid Sequestrants
  Structure

 Mechanism of Digoxin-Cholestyramine Interaction (Severity Level: Moderate)
     Complex formation Click to Show/Hide Mechanism Graph
Could Not Find 2D Structure
      Drug Name Digoxin Cholestyramine
      Mechanism Binds to anion exchange resin/polymer Anion exchange resin/polymer
      Key Mechanism Factor 1
Factor Name Chelation
Factor Description Chelation is a direct drug interaction that usually involves the formation of dimers or trimers, resulting in larger complexes and poorer absorption.
      Mechanism Description
  • Decreased absorption of Cholestyramine due to formation of complexes caused by Digoxin 

Recommended Action
      Management Cholestyramine should be administered at least eight hours before or after a dose of digoxin. It may be prudent to monitor patients for altered clinical response and to monitor digoxin levels. Patients should be advised to notify their physician if they experience worsening of their heart symptoms. Conversely, patients should be monitored for digoxin toxicity after discontinuation of cholestyramine.

References
1 Brown DD, Juhl RP, Warner SL "Decreased bioavailability of digoxin due to hypocholesterolemic interventions." Circulation 58 (1978): 164-72. [PMID: 647881]
2 Hall WH, Shappell SD, Doherty JE "Effect of cholestyramine on digoxin absorption and excretion in man." Am J Cardiol 39 (1977): 213-6. [PMID: 835478]
3 Marcus FI "Pharmacokinetic interactions between digoxin and other drugs." J Am Coll Cardiol 5 (1985): a82-90. [PMID: 2985676]
4 Product Information. Questran (cholestyramine). Par Pharmaceutical Inc, Chestnut Ridge, NY.
5 Rawashdeh NM, al-Hadidi HF, Irshaid YM, Battah AK "Gastrointestinal dialysis of digoxin using cholestyramine." Pharmacol Toxicol 72 (1993): 245-8. [PMID: 8372041]
6 Rodin SM, Johnson BF "Pharmacokinetic interactions with digoxin." Clin Pharmacokinet 15 (1988): 227-44. [PMID: 3056649]