title: Possible digoxin toxicity associated with concomitant ciprofloxacin therapy.
abstract: METHODS
  A 27 year old female with a complex history of congenital heart disease, cardiac surgery, heart failure, and arrhythmias was admitted for a Pseudomonas aeruginosa sternal wound infection and treated with intravenous antibiotics. After discharge and completion of an outpatient course of intravenous antibiotics, suppressive antibiotic therapy with ciprofloxacin was initiated. She presented to clinic with nausea and anorexia within a few days of addition of ciprofloxacin to her current regimen of medications, which included digoxin. The digoxin was discontinued, with all other medications remaining the same, and the symptoms resolved in 48 h. The dose of digoxin was restarted at 50 % of the previous dose with no further complications. The proposed cause of the nausea and anorexia was digoxin toxicity secondary to a drug-drug interaction with ciprofloxacin.
  
  
  CONCLUSIONS
  Patients receiving ciprofloxacin and digoxin should be monitored closely for the risk of digoxin toxicity.
authors.affiliation: Department of Pharmacy, Texas Children's Hospital, 6621 Fannin Street, Suite WB 1120, Houston, TX, 77030, USA, bsmoffet@texaschildrens.org.
authors.forename: Brady S
authors.initials: BS
authors.lastname: Moffett
authors.forename: Santiago O
authors.initials: SO
authors.lastname: Valdes
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Kim
mesh_terms: D000328:Adult; D000855:Anorexia / Q000139:chemically induced; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000009:adverse effects* / Q000627:therapeutic use; D004077:Digoxin / Q000009:adverse effects* / Q000627:therapeutic use; D004347:Drug Interactions; D016903:Drug Monitoring; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy* / Q000628:therapy; D006801:Humans; D009325:Nausea / Q000139:chemically induced; D010138:Pacemaker, Artificial; D011552:Pseudomonas Infections / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D012086:Reoperation / Q000009:adverse effects; D013530:Surgical Wound Infection / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D002316:Cardiotonic Agents; D002939:Ciprofloxacin; D004077:Digoxin