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azithromycin oral

Digoxin, Oral/Macrolide Antibiotics

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.

Medical warning:

Serious. These medicines may interact and cause very harmful effects. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.

How the interaction occurs:

Macrolides may increase the effects of digoxin.

What might happen:

The effects of your digoxin may increase and cause a slow or irregular heartbeat.

What you should do about this interaction:

Let your healthcare professionals (e.g. doctor or pharmacist) know that you are taking these medicines together. The dose of your medicine may need adjusting. Let your doctor know if you have any nausea, vomiting, headaches, fatigue, drowsiness, weakness, disorientation, hallucinations, changes in vision, or a slow/irregular heartbeat.Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.

References:

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2.Chan AL, Wang MT, Su CY, Tsai FH. Risk of digoxin intoxication caused by clarithromycin-digoxin interactions in heart failure patients: a population-based study. Eur J Clin Pharmacol 2009 Dec;65(12):1237-43.
3.Rengelshausen J, Goggelmann C, Burhenne J, Riedel KD, Ludwig J, Weiss J, Mikus G, Walter-Sack I, Haefeli WE. Contribution of increased oral bioavailability and reduced nonglomerular renal clearance of digoxin to the digoxin-clarithromycin interaction. Br J Clin Pharmacol 2003 Jul; 56(1):32-8.
4.Tanaka H, Matsumoto K, Ueno K, Kodama M, Yoneda K, Katayama Y, Miyatake K. Effect of clarithromycin on steady-state digoxin concentrations. Ann Pharmacother 2003 Feb;37(2):178-81.
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8.Ketek (telithromycin) US prescribing information. Sanofi-Aventis U.S. LLC December, 2010.
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10.Hirata S, Izumi S, Furukubo T, Ota M, Fujita M, Yamakawa T, Hasegawa I, Ohtani H, Sawada Y. Interactions between clarithromycin and digoxin in patients with end-stage renal disease. Int J Clin Pharmacol Ther 2005 Jan;43(1):30-6.
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15.Wakasugi H, Yano I, Ito T, Hashida T, Futami T, Nohara R, Sasayama S, Inui K. Effect of clarithromycin on renal excretion of digoxin: interaction with P-glycoprotein. Clin Pharmacol Ther 1998 Jul; 64(1):123-8.
16.Nordt SP, Williams SR, Manoguerra AS, Clark RF. Clarithromycin induced digoxin toxicity. J Accid Emerg Med 1998 May;15(3):194-5.
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34.Lanoxin (digoxin) Tablets US prescribing information. GlaxoSmithKline August, 2012.

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