Why the study?
Does adding verapamil to digoxin alter the steady-state plasma concentrations and renal and biliary clearances of digoxin in patients with chronic atrial fibrillation?
Does adding verapamil to digoxin alter the steady-state plasma concentrations and renal and biliary clearances of digoxin in patients with chronic atrial fibrillation?
Verapamil increases steady-state plasma concentrations of digoxin primarily by inhibiting its biliary clearance, highlighting a clinically significant drug-drug interaction.
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Warrants digoxin level monitoring with verapamil co-use; supports biliary inhibition mechanism but leaves open outcome impact in larger cohorts.
The interaction between digoxin and verapamil was studied in six patients (mean age +/- SD, 61 +/- 5 years) with chronic atrial fibrillation. The effects of adding verapamil (240 mg/day) on steady-state plasma concentrations and renal and biliary clearances of digoxin were studied in a crossover manner. The biliary clearance of digoxin was determined by a duodenal perfusion technique. Verapamil induced a 44% increase in steady-state plasma concentrations of digoxin, from 0.80 +/- 0.24 to 1.15 +/- 0.40 nmol/L (p less than 0.01). The biliary clearance of digoxin decreased by 43%, from 187 +/- 89 to 101 +/- 55 ml/min (p less than 0.05), in the presence of verapamil, whereas the renal clearance was unaffected (153 +/- 31 versus 173 +/- 51 ml/min; difference not significant). Our results indicate that the main inhibitory effect of verapamil on digoxin elimination is on the biliary route.
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Hedman et al. (1991) studied this question.
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