Drug General Information (ID: DDIVBQYK5F)
Drug Name			Doxycycline		Drug Info		Digitoxin		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antiinflammatory Agents				Antiarrhythmic Agents
Structure

Mechanism of Doxycycline-Digitoxin Interaction (Severity Level: Moderate)
Altered intestinal flora Click to Show/Hide Mechanism Graph
Drug Name		Doxycycline				Digitoxin
Mechanism		Alters GI flora				Affected by alters GI flora
Key Mechanism Factor 1
		Factor Name		Intestinal flora
		Factor Description		The intestinal flora has multiple effects on human health, and altering the intestinal microbiota can affect the absorption of drugs and alter their pharmacological effects.
Mechanism Description		Altered absorption of Digitoxin due to GI flora changes caused by Doxycycline

Recommended Action
Management		Clinical monitoring of patient response and tolerance, including laboratory serum digoxin levels is recommended. Digoxin dosage reductions may be required. Patients should be advised to notify their physicians if they experience nausea, anorexia, visual changes, slow pulse, or irregular heartbeats.

References
1	Lindenbaum J, Rund DG, Butler VP Jr, Tse-Eng D, Saha JR "Inactivation of digoxin by the gut flora: reversal by antibiotic therapy." N Engl J Med 305 (1981): 789-94. [PMID: 7266632]
2	Lindenbaum J, Tse-Eng D, Butler VP, Rund DG "Urinary excretion of reduced metabolites of digoxin." Am J Med 71 (1981): 67-74. [PMID: 7246583]
3	Product Information. Lanoxicaps (digoxin). Glaxo Wellcome, Research Triangle Park, NC.
4	Rodin SM, Johnson BF "Pharmacokinetic interactions with digoxin." Clin Pharmacokinet 15 (1988): 227-44. [PMID: 3056649]