Drug General Information (ID: DDIGWS9OUE)
Drug Name			Carmustine		Drug Info		Digoxin		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Alkylating Agents				Antiarrhythmic Agents
Structure

Mechanism of Carmustine-Digoxin Interaction (Severity Level: Moderate)
Altered intestinal mucosa Click to Show/Hide Mechanism Graph
Drug Name		Carmustine				Digoxin
Mechanism		Alteration of intestinal mucosa				Absorption affected by changes in intestinal mucosa
Key Mechanism Factor 1
		Factor Name		Intestinal mucosa
		Factor Description		Intestinal mucosal barrier function is the ability of the intestine to adequately contain microorganisms and molecules in the lumen while maintaining the ability to absorb nutrients. The absorption of drugs may be altered when the intestinal mucosa is disrupted.
Mechanism Description		Decreased absorption of Digoxin due to intestinal mucosa variation caused by Carmustine

Recommended Action
Management		Digoxin serum levels and effectiveness should be monitored closely following the initiation or discontinuation of antineoplastic agents, and the dosage adjusted as necessary.

References
1	Bjornsson TD, Huang AT, Roth P, Jacob DS, Christenson R "Effects of high-dose cancer chemotherapy on the absorption of digoxin in two different formulations." Clin Pharmacol Ther 39 (1986): 25-8. [PMID: 3943266]
2	Kuhlmann J, Wilke J, Rietbrock N "Cytostatic drugs are without significant effect on digitoxin plasma level and renal excretion." Clin Pharmacol Ther 32 (1982): 646-51. [PMID: 6897028]
3	Kuhlmann J, Zilly W, Wilke J "Effects of cytostatic drugs on plasma level and renal excretion of beta-acetyldigoxin." Clin Pharmacol Ther 30 (1981): 518-27. [PMID: 7285486]
4	Product Information. Lanoxicaps (digoxin). Glaxo Wellcome, Research Triangle Park, NC.
5	Rodin SM, Johnson BF "Pharmacokinetic interactions with digoxin." Clin Pharmacokinet 15 (1988): 227-44. [PMID: 3056649]