A case is reported of a 71-year-old woman who displayed altered absorption of digoxin, quinidine sulfate, and warfarin sodium after being given sucralfate. The administration of sucralfate resulted in subtherapeutic serum concentrations of digoxin and quinidine, and also reduced the patient's prothrombin time (PT). Discontinuation of sucralfate increased PT and reestablished therapeutic concentrations of digoxin, quinidine, and warfarin. Patients receiving sucralfate concomitantly with digoxin, quinidine, and warfarin should be monitored frequently with regard to serum drug concentration and disease symptomatology.
Get full access to this article
View all access options for this article.
References
1.
LindenbaumJMellowMHBlackstoneMOButlerVP. Variation in biologic availability of digoxin from four preparations. N Engl J Med1971; 285: 1344–7.
2.
ZinnyMATaggartWV. Bioavailability of two manufacturers' sustained-release quinidine gluconate tablets at steady state. Clin Ther1984; 7: 22–7.
3.
PorterRSSawyerWTLowenthalDT. Warfarin. In: EvansWESchentagJJJuskoWJ, eds. Applied pharmacokinetics: Principles of therapeutic drug monitoring. 2nd ed. Vancouver, WA: Applied Therapeutics, 1986: 1057–104.
4.
BrownDDJuhlRP. Decreased bioavailability of digoxin due to antacids and kaolin-pectin. N Engl J Med1976; 295: 1034–7.
5.
MauroVFMauroLSFrakerTDJrTemsey-ArmosPNSomaniP. Effect of aluminum hydroxide gel on quinidine gluconate absorption. DICP Ann Pharmacother1990; 24: 2524.
6.
RobinsonDSBenjaminDMMcCormackJJ. Interaction of warfarin and nonsystemic gastrointestinal drugs. Clin Pharmacol Ther1971; 12: 491–5.
7.
ParpiaSHNixDEHejmanowskiLG, Sucralfate reduces the gastrointestinal absorption of norfloxacin. Antimicrob Agents Chemother1989; 33: 99–102.
8.
YukJHNightingaleCNQuintilianiR. Ciprofloxacin levels when receiving sucralfate (letter). JAMA1989; 262: 901.
9.
GiesingDHLanmanRCDimittDCRunserDJ. Lack of effect of sucralfate on digoxin pharmacokinetics (abstract). Gastroenterology1983; 84: 1165.
