Digoxin

The role of intestinal bacterial metabolism is important in the action of the cardiac glycoside drug digoxin (82). In order to form a pharmacologically active drug, the bacterial flora has to remove a trisacchride from the parent compound, releasing digoxigenin. The bacterial intestinal flora can further reduce the double bond in the lactone ring to form dihydrodigoxigenin (82). This compound is pharmacologically inactive. It was found that 36% of Americans in New York city given digoxin had the capability to reduce the double bond forming the inactive metabolite of digoxin (83). A total of 14% of New Yorkers excreted large amounts of metabolites of digoxin. These findings indicate at least 14%, and possibly a greater percentage of the population receiving digoxin will not achieve predicted serum levels resulting from the action of the intestinal microflora. Studies on a population residing in southern India indicated only 13.7% of those tested could reduce digoxin, and only 1% excreted large amounts of metabolites (83). These studies indicate that there are interethnic variations in the metabolic capacity of the intestinal microflora to reduce the double bond in the lactone ring of digoxin. This finding is not surprising based on the observation that Eubacterium lentum is exclusively responsible for the reductive reaction (82).

Pregnancy And Childbirth

Pregnancy And Childbirth

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