The mechanism of the interaction between digoxin and quinidine
- 101 Downloads
- 2 Citations
Abstract
The mechanism of the recently reported interaction between digoxin and quinidine was investigated.
We found a statistically significant decrease in renal clearance of digoxin after adding quinidine to the treatment regime. In 4 patients the digoxin/creatinine renal clearance ratio during quinidine treatment (0.74±0.23, mean ±S.D.) differed significantly (P<0.01) from the ratio after quinidine therapy (1.11±0.20, mean ±S.D.). The ratio was 0.85±0.23 (mean ±S.D.) in 15 patients receiving simultaneous quinidine therapy and 1.22± 0.31 (mean ±S.D.) in 44 patients without quinidine therapy. This difference was significant (P<0.01).
Quinidine did not influencein vitro the distribution of digoxin between plasma and erythrocytes.
The elevation of the serum digoxin level during quinidine therapy can be explained partly by a decrease of the renal digoxin clearance. Our results, however, do not exclude that other mechanisms may also be involved.
Keywords
Digoxin Quinidine Digoxin Concentration Serum Digoxin Concentration Clearance RatioPreview
Unable to display preview. Download preview PDF.
References
- Binnion, P. F. (1978) Drug interactions with digitalis glycosides,Drugs 15, 369.CrossRefPubMedGoogle Scholar
- Bloom, Ph. M., andW. B. Nelp (1966) Relationship of the excretion of tritiated digoxin to renal function,Am. J. Med. Sci. 43, 133.CrossRefGoogle Scholar
- Doering, W., andE. König (1978) Anstieg der Digoxinkonzentration im Serum unter Chinidinmedikation,Med. Klin. 73, 1085.PubMedGoogle Scholar
- Doherty, J. E., andJ. J. Kane (1975) Clinical pharmacology of digitalis glycosides,Ann. Rev. Med. 26, 159.CrossRefPubMedGoogle Scholar
- Doherty, J. E., andW. H. Perkins (1962) Studies with tritiated digoxin in human subjects after intravenous administration,Am. Heart J. 63, 528.CrossRefPubMedGoogle Scholar
- Ejvinsson, G. (1978) Effect of quinidine on plasma concentrations of digoxin,Brit. Med. J. 1, 279.CrossRefPubMedPubMedCentralGoogle Scholar
- Evered, D. C. (1972) The binding of digoxin by the serum proteins,Eur. J. Pharmacol. 18, 236.CrossRefPubMedGoogle Scholar
- Halkin, H., L. B. Sheiner, C. C. Peck andK. L. Melmon (1975) Determinants of the renal clearance of digoxin,Clin. Pharmacol. Therap. 17, 385.CrossRefGoogle Scholar
- Hooymans, P. M., andF. W. H. M. Merkus (1978) Effect of quinidine on plasma concentration of digoxin,Brit. Med. J. 2, 1022.CrossRefPubMedPubMedCentralGoogle Scholar
- Huffman, D. H., C. V. Manion andD. L. Azarnoff (1975) Intersubject variation of digoxin in normal volunteers,J. Pharm. Sci. 64, 433.CrossRefPubMedGoogle Scholar
- Iisalo, E., andI. Ruikka (1974) Serum levels and renal excretion of digoxin in the elderly. A comparison between three different preparations,Acta Med. Scand. 196, 59.CrossRefPubMedGoogle Scholar
- Leahey, E. B., J. A. Reiffel, R. E. Drusin, R. H. Heisenbuttel, W. P. Lovejoy andJ. Th. Bigger (1978) Interaction between quinidine and digoxin,J. Am. Med. Assoc. 240, 533.CrossRefGoogle Scholar
- Nyberg, L., K. E. Andersson andå. Bertler (1974) Bioavailability of digoxin from tablets. Radioimmunoassay and disposition pharmacokinetics of digoxin after intravenous administration,Acta Pharm. Suecica 11, 459.Google Scholar
- Reuning, R. H., R. A. Sams andR. E. Notari (1973) Role of pharmacokinetics in drug dosage adjustment. Pharmacologic effect, kinetics and apparent volume of distribution of digoxin,J. Clin Pharmacol. 13, 127.Google Scholar
- Steiness, E. (1974) Renal tubular secretion of digoxin,Circulation 50, 103.CrossRefPubMedGoogle Scholar