Drug General Information (ID: DDIOP6GZQJ)
Drug Name			Digoxin		Drug Info		Kaolin		Drug Info
Drug Type		Small molecule				Natural product
Therapeutic Class		Antiarrhythmic Agents				Herbal Products
Structure

Mechanism of Digoxin-Kaolin Interaction (Severity Level: Moderate)
Complex formation Click to Show/Hide Mechanism Graph
Drug Name		Digoxin				Kaolin
Mechanism		Binds to polyvalent cations				Polyvalent cations
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 Kaolin due to formation of complexes caused by Digoxin

Recommended Action
Management		To minimize the potential for interaction, patients should be advised to take kaolin-pectin at least 2 hours after digoxin if possible. The same precaution may be applicable during therapy with digitoxin, although clinical data are lacking.

References
1	Albert KS, Ayres JW, DiSanto AR, Weidler DJ, Sakmar E, Hallmark MR, Stoll RG, DeSante KA, Wagner JG "Influence of kaolin--pectin suspension on digoxin bioavailability." J Pharm Sci 67 (1978): 1582-6. [PMID: 712596]
2	Allen MD, Greenblatt DJ, Harmatz JS, Smith TW "Effect of magnesium--aluminum hydroxide and kaolin--pectin on absorption of digoxin from tablets and capsules." J Clin Pharmacol 21 (1981): 26-30. [PMID: 7012189]
3	Brown DD, Juhl RP "Decreased bioavailability of digoxin due to antacids and kaolin-pectin." N Engl J Med 295 (1976): 1034-7. [PMID: 972657]
4	Marcus FI "Pharmacokinetic interactions between digoxin and other drugs." J Am Coll Cardiol 5 (1985): a82-90. [PMID: 2985676]
5	Rodin SM, Johnson BF "Pharmacokinetic interactions with digoxin." Clin Pharmacokinet 15 (1988): 227-44. [PMID: 3056649]