Clarithromycin (Antibacterial) & Digoxin (Antiarrythmic)

Digoxin is a substrate for P-glycoprotein (Pgp) and clarithromycin is known to inhibit Pgp. When
clarithromycin and digoxin are co-administered, inhibition of Pgp by clarithromycin may lead to
increased exposure of digoxin. Elevated digoxin serum concentrations in patients receiving
clarithromycin and digoxin concomitantly have been reported in post-marketing surveillance. Some
patients have shown clinical signs consistent with digoxin toxicity, including potentially fatal
arrhythmias. Monitoring of serum digoxin concentrations should be considered, especially for patients
with digoxin concentrations in the upper therapeutic range.
Neomycin: Anti-infective
Neomycin can decrease absorption or increase elimination of many nutrients, including calcium,
carbohydrates, beta-carotene, fats, folic acid, iron, magnesium, potassium, sodium, and vitamin
A, vitamin B12, vitamin D, and vitamin K. Surgery preparation with oral neomycin is unlikely to lead to
deficiencies. It makes sense for people taking neomycin for more than a few days to also take
a multivitamin-mineral supplement.
Tetracycline: Antibacterial
Calcium and other minerals can combine with tetracyclines so that the antibiotics are not absorbed into
the body. Make sure you don't take any mineral supplements or mineral-containing antacids within 2
hours of a tetracycline pill. Long-term use of tetracycline may deplete these nutrients and require
supplementation.
How can a clinical pharmacist prevent drug intxn?
- Clinical pharmacists care for patients in all health care settings. They possess indepth
knowledge of medications that is integrated with a foundational understanding of the biomedical,
pharmaceutical, sociobehavioral, and clinical sciences. To achieve desired therapeutic goals, the clinical
pharmacist applies evidence-based therapeutic guidelines, evolving sciences, emerging technologies,
and relevant legal, ethical, social, cultural, economic and professional principles. Accordingly, clinical
pharmacists assume responsibility and accountability for managing medication therapy in direct patient
care settings, whether practicing independently or in consultation/collaboration with other health care
professionals. Clinical pharmacist researchers generate, disseminate, and apply new knowledge
that contributes to improved health and quality of life. Within the system of health care, clinical
pharmacists are experts in the therapeutic use of medications. They routinely provide medication therapy
evaluations and recommendations to patients and health care professionals. Clinical pharmacists are
a primary source of scientifically valid information and advice regarding.
How can the risk of drug intxn be minimized?
Pay attention to how your body responds to medicines and be sensitive to side effects. Dont assume
these side effects are normal. You can help prevent some interactions by becoming a wiser health
consumer.
-

Read labels and package inserts carefully. Pay particular attention to the "Warning" and
"Precaution" sections. Review this information each time you get a refill; guidelines for use
change as more is learned.

Brownbag your medications. You are the only person who knows everything you are taking. The
next time you have an appointment with your health care provider, take all your medications
with you. Include medications prescribed by other doctors and any over-the-counter drugs.
Dont forget any supplements or vitamins you are taking. Dont assume your doctor knows
everything you are taking. Make sure you ask your provider about possible interactions.
Ask your doctor, nurse, or pharmacist to help you work out a daily schedule for taking your
medication. Some interactions may be avoided by taking the medications at different times.
Keep a list of your medications in your medicine cabinet and a copy in your wallet or
pocketbook.
Before you take a new medication ask:

What is the name of this medication?

Can I take this with other medicines?
Should I avoid certain foods, beverages, or other products?
What should I look for? What kinds of reactions are possible?
How does this medicine work in the body?
What other kinds of precautions are necessary?
Is there additional written information that I could read about the medicine?

Go to one pharmacy for all your prescriptions. Good record-keeping can reduce the risk of
interactions. Many pharmacies have their records computerized.
Dont use outdated drugs, drugs that appear to have been tampered with, or drugs given to you
for another condition.
Know ahead of time what to do if anything goes wrong when taking medicines. Know whom to
contact and how to reach him/her. Keep phone numbers of your doctors on hand next to the
telephone and on a card you carry in your wallet or purse.