Ciprofloxacin/digoxin interaction
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Digoxin toxicity: case report A 27-year-old woman experienced possible digoxin toxicity while receiving ciprofloxacin and digoxin concurrently. The woman was admitted with a Pseudomonas aeruginosa sternal wound infection following cardiac surgery. She was initiated on IV ceftazidime and gentamicin therapy, and maintained on her home medications which included oral digoxin 250mcg daily [indication not stated]. She was discharged home, and after 6 weeks of ceftazidime therapy, was started on enteral ciprofloxacin 500mg daily for 12 months as prophylactic suppressive therapy against P. aeruginosa infection. She presented a few days after commencing ciprofloxacin with complaints of anorexia and nausea. She reported that these symptoms occurred in the morning about 2–3 hours after taking all her medications, including digoxin and ciprofloxacin. The symptoms resolved by early evening, and did not recur after she took her evening medications, which did not include ciprofloxacin or digoxin. The type and timing of the symptoms raised concern for digoxin toxicity. The woman was given a trial withdrawal of digoxin for 48 hours, while ciprofloxacin was continued. After 2 days, she reported total resolution of the anorexia and nausea. Digoxin was subsequently restarted at 50% of the original dose, and there were no further symptoms of digoxin toxicity noted. Author comment: "On the Naranjo scale, which is used to identify adverse drug events, the authors calculated a score of 3, indicating a possible adverse drug event. On the drug interaction probability scale (DIPS), the authors also calculated a 3 (classifying digoxin as the object drug and ciprofloxacin as the precipitant drug), indicating a possible drug-drug interaction". Moffett BS, et al. Possible digoxin toxicity associated with concomitant ciprofloxacin therapy. International Journal of Clinical Pharmacy 35: 673-676, No. 5, Oct 2013. Available from: URL: http://dx.doi.org/10.1007/s11096-013-9818-4 803096428 USA
0114-9954/13/1481-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved
Reactions 7 Dec 2013 No. 1481
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