digoxin and Bronchitis

Recently it has been recognized that steady-state serum digoxin concentrations may increase or fall to ineffective levels when the glycoside is administered together with several antibiotics. Our study was designed to assess if serum digoxin levels may be modified by the concomitant use of a ticarcillin and clavulanic acid. The study was carried out in 15 hospitalized patients suffering from exacerbation of their chronic bronchitis without liver disease and renal failure. Serum digoxin levels were not significantly modified by the concomitant use of a ticarcillin and clavulanic acid, although peak digoxin serum concentrations were slightly lower. However, the average time to achieve the maximum concentration and area under the curve over 24 h did not change.

Topics: Aged; Bronchitis; Chronic Disease; Clavulanic Acids; Digoxin; Drug Interactions; Drug Therapy, Combination; Female; Humans; Lung Diseases, Obstructive; Male; Middle Aged; Ticarcillin

A 58-year-old woman who had been taking digoxin 0.25 mg/day for more than 35 years for heart palpitations after mitral valve repair was prescribed a 5-day course of telithromycin for acute bronchitis. On the sixth day of therapy, she came to the emergency department complaining of general malaise and having experienced three episodes of syncope over the previous 2 days. Laboratory analysis revealed elevated digoxin plasma levels, and electrocardiography showed several nonspecific repolarization anomalies. Telithromycin is known to increase digoxin plasma levels; however, the clinical significance of this interaction is not known. To our knowledge, this is the first report of elevated plasma digoxin levels associated with signs and symptoms of toxicity. This drug interaction-determined as probable according to the Naranjo adverse drug reaction probability scale-may be mediated by P-glycoprotein. By inhibiting the transport of digoxin by P-glycoprotein, telithromycin may have decreased digoxin elimination in the intestinal lumen and its renal tubular excretion, resulting in elevated plasma levels and drug toxicity. Clinicians should be aware of possible digoxin toxicity after concomitant administration with telithromycin, especially in patients who are at risk, such as those with electrolyte abnormalities and decreased renal function.

Topics: Acute Disease; Bronchitis; Digoxin; Drug Interactions; Electrocardiography; Female; Heart; Humans; Ketolides; Middle Aged

To report a case of clarithromycin-induced digoxin intoxication.. A 78-year-old white man with ischemic cardiomyopathy and chronic renal insufficiency was admitted 4 days after being prescribed clarithromycin for a suspected episode of bronchitis. He reported weakness, asthenia, and gastrointestinal symptoms; the digoxin serum concentration was measured at 3.89 ng/mL. The patient recovered uneventfully after digoxin and clarithromycin were discontinued.. Erythromycin frequently interacts with other drugs that are also metabolized by the CYP3A4 isoenzyme. However, erythromycin is hypothesized to interact with digoxin by inhibiting Eubacterium lentum, which is a normal inhabitant of the human gut and is responsible for intestinal metabolism of digoxin in 10% of patients. Since clarithromycin shares a comparable antibacterial spectrum with erythromycin, the possibility of a drug interaction with digoxin remains. Only four cases of clarithromycin interacting with digoxin have been reported to date. Clinically, this interaction may have been more obvious because of our patient's moderate renal dysfunction and serum digoxin concentrations in the upper therapeutic range prior to clarithromycin initiation. Other causes for digoxin intoxication could not be identified.. Clarithromycin may inhibit the growth of E. lentum, which can lead to an increase in digoxin bioavailability and blood concentrations in patients in whom this intestinal metabolic pathway is present. Patients at risk include those with renal dysfunction, with serum concentrations in the upper therapeutic range, or with measured digoxin concentrations that are much lower than predicted by pharmacokinetic calculations. For these patients, appropriate therapy includes the selection of an alternative, noninteracting antibiotic or, if this is not possible, a temporary reduction of digoxin dosage.

Topics: Aged; Anti-Arrhythmia Agents; Anti-Bacterial Agents; Blood Pressure; Bronchitis; Cardiomyopathies; Clarithromycin; Digoxin; Drug Interactions; Heart Rate; Humans; Kidney Failure, Chronic; Male

Topics: Aged; Aged, 80 and over; Atrial Premature Complexes; Bronchitis; Clarithromycin; Digoxin; Drug Interactions; Female; Humans

Combined therapy including digoxin improves the patients' clinical status and hemodynamics producing a normalizing effect on cardiac ejection, raises myocardial contractility, reduces pulmonary hypertension. The use of digoxin improves pulmonary metabolic function, lowers a degree of hypoxia. Combined evaluation of clinicofunctional data with regard for the dynamic determination of digoxin plasma concentration allows more effective glycoside therapy preventing the development of intoxication and resulting in a noticeable therapeutic effect. The use of digoxin is effective for initial and advanced stages of cardiopulmonary incompetence.

Topics: Adult; Bronchitis; Chronic Disease; Digoxin; Dose-Response Relationship, Drug; Drug Evaluation; Heart Failure; Hemodynamics; Humans; Middle Aged; Respiratory Insufficiency

Topics: Aged; Aminophylline; Anti-Bacterial Agents; Asthma; Bronchitis; Digoxin; Diuretics; Emergencies; Expectorants; Humans; Hypoxia; Lung; Prednisolone; Respiration, Artificial; Terbutaline; Vital Capacity

This survey deals with the 5 most important internal problems of old aged people undergoing surgery: chronic emphysematous bronchitis, geriatric heart, Diabetes mellitus, bleeding tendency during operation and venous thromboembolism.

Topics: Aged; Bandages; Blood Coagulation Disorders; Bronchitis; Diabetes Mellitus; Digitoxin; Digoxin; Emphysema; Exercise Therapy; Heart Failure; Humans; Hypoglycemic Agents; Preoperative Care; Respiratory Therapy; Strophanthins; Thromboembolism

Topics: Aged; Asthma; Bronchitis; Carbon Dioxide; Cardiac Catheterization; Conjunctiva; Diet, Sodium-Restricted; Digoxin; Edema; Eye Diseases; Female; Furosemide; Heart Failure; Humans; Hyperemia; Male; Middle Aged; Oxygen; Oxygen Inhalation Therapy; Potassium Chloride; Pulmonary Emphysema; Pulmonary Fibrosis; Pulmonary Heart Disease; Respiratory Insufficiency; Veins

Topics: Acetanilides; Adrenergic beta-Antagonists; Adult; Amino Alcohols; Atrial Flutter; Bronchitis; Bronchodilator Agents; Caffeine; Digoxin; Electrocardiography; Humans; Male; Middle Aged; Nicotine; Sympatholytics; Tachycardia; Vagus Nerve

Digitalis glycosides remain the cornerstone of treatment in cardiac failure. The increasing frequency of toxic effects is a cause for concern. Review of 80 elderly patients receiving digoxin on a maintenance basis, some of whom had toxic effects, shows that in almost three-quarters of the group digoxin was stopped without detriment. Elderly patients on maintenance treatment should be reviewed, and in the absence of a known primary cardiac lesion an attempt should be made to withdraw digoxin.

Topics: Aged; Bronchitis; Digoxin; Female; Heart Failure; Humans; Hypertension; Male; Middle Aged; Tachycardia

Topics: Asthma; Bronchitis; Bronchopneumonia; Digoxin; Heart Failure; Humans; Infant; Lanatosides

Topics: Arrhythmias, Cardiac; Bronchitis; Brugada Syndrome; Cardiac Conduction System Disease; Digitalis; Digoxin; Electrocardiography; Geriatrics; Heart Conduction System; Heart Failure; Humans; Hypertension; Poisoning; Toxicology

Topics: Asthma; Biomedical Research; Blood Pressure; Blood Pressure Determination; Bronchitis; Cardiac Catheterization; Digitalis; Digoxin; Electrocardiography; Eosinophilia; Humans; Lung Diseases; Pharmacology; Pulmonary Artery; Pulmonary Emphysema