Journal article
Decreased Bioavailability of Digoxin Due to Antacids and Kaolin-Pectin
The New England journal of medicine, Vol.295(19), pp.1034-1037
11/04/1976
DOI: 10.1056/NEJM197611042951902
PMID: 972657
Abstract
Employing a Latin-square design and single-dose studies of bioavailability in 10 normal human volunteers, we tested the hypothesis that antacids and kaolin-pectin might interfere with the bioavailability of orally administered digoxin. Cumulative six-day urinary digoxin excretion (expressed as the percentage of a 0.75-mg dose recovered) was: control, 40.1 ±3.0 (S.E.); aluminum hydroxide, 30.7±2.9; magnesium hydroxide, 27.1 ±2.4; magnesium trisilicate, 29.1 ±1.7; and kaolin-pectin 23.4±2.0. The differences in means were highly significant (F = 10.47, P<0.005). Further analysis (multiple comparison test) revealed that control differed significantly from each of the other treatments (α = 0.05), but there was no such difference between any of the other treatment groups. The decreased cumulative excretion produced by antacids and kaolin-pectin reflected a striking reduction in digoxin absorption associated with these compounds that was not related to alteration of gut transit time or to adsorption of digoxin to these gastrointestinal medications. (N Engl J Med 295:1034–1037, 1976)
Variability in the bioavailability of digoxin under various clinical circumstances is becoming increasingly apparent. Interactions with other medications during gastrointestinal absorption is a case in point. Antacids have had varying effects on the absorption of various other medications. Magnesium hydroxide appears to enhance absorption of bishydroxycoumarin.
1
In contrast, aluminum hydroxide appears to diminish the absorption of tetracycline,
2
apparently owing to physical adsorption of the antibiotic to the antacid. Blaug and Gross demonstrated similar physical adsorption of various anticholinergic preparations to antacids, with magnesium trisilicate showing the highest adsorptive capacity.
3
Recently, in vitro physical adsorption of digoxin has been demonstrated with . . .
Details
- Title: Subtitle
- Decreased Bioavailability of Digoxin Due to Antacids and Kaolin-Pectin
- Creators
- Donald D BrownKathy LewisRandy P JuhlMara SchrottBrenda Bartels
- Resource Type
- Journal article
- Publication Details
- The New England journal of medicine, Vol.295(19), pp.1034-1037
- Publisher
- Massachusetts Medical Society
- DOI
- 10.1056/NEJM197611042951902
- PMID
- 972657
- ISSN
- 0028-4793
- eISSN
- 1533-4406
- Language
- English
- Date published
- 11/04/1976
- Academic Unit
- Cardiovascular Medicine; Internal Medicine
- Record Identifier
- 9984094748302771
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