Didanosine(continued)
▶Didanosineincreases the risk of toxicity when given with
stavudine. Avoid.rStudy→Also seeTABLE 12p. 850
▶Tenofovir disoproxilincreases the risk of toxicity when given
withdidanosine. Avoid.rStudy
▶Valgancicloviris predicted to increase the exposure to
didanosine.oStudy
Digoxin→seeTABLE 6p. 848 (bradycardia)
GENERAL INFORMATIONDrugs that reduce serum potassium are
predicted to increase the risk of digoxin toxicity, seeTABLE 17
p. 851.
▶Acarbosedecreases the concentration ofdigoxin.o
Study
▶Aldosterone antagonists(eplerenone)very slightly increase the
exposure todigoxin.nStudy
▶Aldosterone antagonists(spironolactone)increase the
concentration ofdigoxin. Monitor and adjust dose.o
Study
▶Aminoglycosidespotentially increase the concentration of
digoxin. Monitor and adjust dose.nStudy
▶Antacidsdecrease the absorption ofdigoxin. Separate
administration by 2 hours.nStudy
▶Antiarrhythmics(amiodarone, dronedarone)are predicted to
moderately increase the exposure todigoxin. Monitor and
adjustdigoxindose,p. 81.rStudy→Also seeTABLE 6p. 848
▶Antiarrhythmics(propafenone)increase the concentration of
digoxin. Monitor and adjust dose.rStudy
▶Antiepileptics(fosphenytoin, phenytoin)are predicted to
decrease the concentration ofdigoxin.oAnecdotal
▶Antifungals, azoles(isavuconazole)slightly increase the
exposure todigoxin. Monitor and adjust dose.oStudy
▶Antifungals, azoles(itraconazole)are predicted to markedly
increase the concentration ofdigoxin. Monitor and adjust
dose.rStudy
▶Antifungals, azoles(ketoconazole)are predicted to markedly
increase the concentration ofdigoxin.rStudy
▶Antifungals, azoles(posaconazole)are predicted to increase the
concentration ofdigoxin.rStudy
▶Antimalarials(mefloquine)are predicted to increase the risk of
bradycardia when given withdigoxin.rTheoretical
▶Antimalarials(quinine)increase the concentration ofdigoxin.
Monitor and adjustdigoxindose,p. 81.rAnecdotal
▶Balsalazideis predicted to decrease the concentration of
digoxin.oTheoretical
▶Calcium channel blockers(diltiazem, verapamil)increase the
concentration ofdigoxin. Monitor and adjust dose.r
Study→Also seeTABLE 6p. 848
▶Intravenouscalcium saltsincrease the concentration of
digoxin. Avoid.oAnecdotal
▶Carbimazoleaffects the concentration ofdigoxin. Monitor and
adjust dose.oTheoretical
▶Ceritinibis predicted to increase the risk of bradycardia when
given withdigoxin. Avoid.rTheoretical
▶Ciclosporinincreases the concentration ofdigoxin. Monitor
and adjust dose.rTheoretical
▶Daclatasvirslightly increases the concentration ofdigoxin.
rStudy
▶Eliglustatincreases the exposure todigoxin. Adjust dose.
oStudy
▶Glecaprevir(with pibrentasvir) increases the exposure to
digoxin.oStudy
▶HIV-protease inhibitors(ritonavir)increase the concentration of
digoxin. Adjust dose and monitor concentration.rStudy
▶Ivacaftorslightly increases the exposure todigoxin.o
Study
▶Lapatinibis predicted to increase the exposure todigoxin.
oTheoretical
▶Macrolidesincrease the concentration ofdigoxin.r
Anecdotal
▶Mirabegronslightly increases the exposure todigoxin. Monitor
concentration and adjust dose.rStudy
▶Neomycindecreases the absorption ofdigoxin.oStudy
▶Neuromuscular blocking drugs, non-depolarising(pancuronium)
are predicted to increase the risk of cardiovascular side-
effects when given withdigoxin.rAnecdotal▶NSAIDs(indometacin)increase the concentration ofdigoxin.
rStudy
▶Penicillaminepotentially decreases the concentration of
digoxin. Separate administration by 2 hours.rAnecdotal
▶Pibrentasvir(with glecaprevir) increases the exposure to
digoxin.oStudy
▶Pitolisantis predicted to decrease the exposure todigoxin.
qTheoretical
▶Ranolazineincreases the concentration ofdigoxin.o
Study
▶Rifampicindecreases the concentration ofdigoxin.o
Study
▶Rolapitantslightly increases the exposure todigoxin.o
Study
▶St John’s Wortdecreases the concentration ofdigoxin. Avoid.
rAnecdotal
▶Sucralfatedecreases the absorption ofdigoxin. Separate
administration by 2 hours.rAnecdotal
▶Sulfasalazinedecreases the concentration ofdigoxin.o
Study
▶Suxamethoniumis predicted to increase the risk of
cardiovascular side-effects when given withdigoxin.r
Anecdotal
▶Thyroid hormonesare predicted to affect the concentration of
digoxin. Monitor and adjust dose.oTheoretical
▶Ticagrelorincreases the concentration ofdigoxin.o
Study
▶Tolvaptanincreases the concentration ofdigoxin.nStudy
▶Trimethoprimincreases the concentration ofdigoxin.o
Study
▶Vandetanibslightly increases the exposure todigoxin. Monitor
ECG and adjust dose.oStudy
▶Velpatasviris predicted to increase the exposure todigoxin.
rStudy
▶Vitamin D substancesare predicted to increase the risk of
toxicity when given withdigoxin.rTheoretical
Dihydrocodeine→see opioids
Dihydrotachysterol→see vitamin D substances
Diltiazem→see calcium channel blockers
Dimenhydrinate→seeTABLE 10p. 849 (antimuscarinics)
Dimethyl fumarate
▶Alcohol (beverage)(excessive consumption) potentially
increases the risk of gastrointestinal side-effects when given
withdimethyl fumarate. Avoid.oTheoretical
▶Live vaccinesare predicted to increase the risk of generalised
infection (possibly life-threatening) when given withdimethyl
fumarate. Public Health England advises avoid (refer to Green
Book).rTheoretical
Diphenoxylate→see opioids
Dipipanone→see opioids
Dipyridamole→seeTABLE 8p. 848 (hypotension),TABLE 4p. 847
(antiplatelet effects)
▶Antacidsare predicted to decrease the absorption of
dipyridamole(immediate release tablets).oTheoretical
▶Dipyridamoleincreases the exposure toantiarrhythmics
(adenosine). Avoid or adjust dose.rStudy
▶H 2 receptor antagonistsare predicted to decrease the
absorption ofdipyridamole(immediate release tablets).
oTheoretical
▶Proton pump inhibitorsare predicted to decrease the
absorption ofdipyridamole(immediate release tablets).
oTheoretical
Disopyramide→see antiarrhythmics
Disulfiram→seeTABLE 12p. 850 (peripheral neuropathy)
▶Alcohol (beverage)causes an extremely unpleasant systemic
reaction when given withdisulfiram. Avoid for at least
24 hours before and up to 14 days after stopping treatment.
rStudy
▶Disulfiramincreases the concentration ofantiepileptics
(fosphenytoin, phenytoin). Monitor concentration and adjust
dose.rStudy→Also seeTABLE 12p. 850
▶Disulfiramincreases the anticoagulant effect ofcoumarins.
Monitor and adjust dose.rStudy
▶Disulfiramincreases the risk of acute psychoses when given
withmetronidazole.rStudy→Also seeTABLE 12p. 850910 Didanosine—Disulfiram BNFC 2018 – 2019
Interactions|Appendix 1A1