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Digoxin - Interactions and Warnings

Possible decrease in the bioavailability of digoxin when combined with St John's wort
- Lancet 2000 Jan 8;355(9198):134-8 -- Herb-drug interactions. -- Fugh-Berman A.

Patients taking drugs with a narrow therapeutic index such as digoxin should be discouraged from using herbal products. All drugs with a narrow therapeutic index may either have increased adverse effects or be less effective when used in conjunction with herbal products.
- Crit Care Nurse 2002 Apr;22(2):22-8, 30, 32; quiz 34-5 -- Herbal remedies: drug-herb interactions. -- Kuhn MA.

A man taking a constant dose of digoxin for many years was found to have an elevated serum digoxin level with no signs of toxic effects. The patient revealed that he was taking Siberian ginseng. The patient stopped taking ginseng, and the serum digoxin level soon returned to an acceptable level. The digoxin therapy was resumed. The patient resumed taking ginseng several months later, and the serum digoxin level again rose. Digoxin therapy was maintained at a constant daily dose, the ginseng was stopped once more, and the serum digoxin levels again returned to within the therapeutic range. It is unclear whether some component of the ginseng was converted to digoxin in vivo, interfered with digoxin elimination or caused a false serum assay result.
- CMAJ 1996 Aug 1;155(3):293-5 -- Elevated serum digoxin levels in a patient taking digoxin and Siberian ginseng. -- McRae S. Consult with your physician before using herbs or herbal products.

last update: November 2008

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