Key result
Quinidine reduces biliary clearance of digoxin by ~42%.
Why the study?
The effect of quinidine on biliary clearance of digoxin in humans was not previously demonstrated and does not fully explain its influence on total digoxin clearance.
Does quinidine reduce biliary clearance of digoxin in patients with atrial fibrillation?
Does quinidine reduce biliary clearance of digoxin in patients with atrial fibrillation?
Quinidine reduces the biliary clearance of digoxin, providing the first evidence in humans of a pharmacokinetic drug interaction at the level of biliary excretion.
Answers are grounded in this paper and cite their sources.
May explain residual quinidine-digoxin interaction beyond renal effects; leaves open dosing implications pending larger studies.
Quinidine is known to reduce the renal clearance of digoxin, but this effect does not completely explain the influence of quinidine on the total clearance of digoxin. We therefore studied the effect of quinidine administration on biliary clearance of digoxin in five patients with atrial fibrillation. Biliary clearance of digoxin under steady state conditions before and during treatment with quinidine was investigated using a duodenal-marker-perfusion technique. Quinidine caused an average 42% (range 21-65%, P less than 0.02) reduction of the measured biliary clearance of digoxin. We conclude that the biliary effect adds to the previously demonstrated inhibitory effect of quinidine on the renal clearance of digoxin and helps to explain the decrease in total clearance of the drug. This is the first demonstration in man of a pharmacokinetic drug interaction at the level of biliary excretion.
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Angelin et al. (1987) studied Atrial fibrillation (n=5). Quinidine vs. Baseline (before treatment) was evaluated on Biliary clearance of digoxin (42% reduction, p=<0.02). Quinidine administration caused an average 42% reduction in the biliary clearance of digoxin (P<0.02).
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