Effect of Quinine on Plasma Digoxin Concentration and Renal Digoxin Clearance

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Abstract
In order to explore the digoxin-quinine interaction, digoxin steady state pharmacokinetics was studied before and during quinine coadministration in seven healthy subjects. Quinine (250 mg/day) increased mean plasma digoxin concentration from 0.64 .+-. 0.12 to 0.80 .+-. 0.18 ng/ml (p < 0.05) within one week. Urinary digoxin recovery rose from 154.0 .+-. 18.8 to 181.5 .+-. 22.6 .mu.g/24 h (p < 0.01), whereas renal digoxin clearance was unaltered in the presence of quinine (181.5 .+-. 24.2 vs. 174.1 .+-. 26.5 ml/min). An increase in quinine dose (to 750 mg/day) caused further increments in plasma digoxin levels, whereas renal digoxin clearance remained unchanged. Quinine elevates plasma digoxin concentrations in a stepwise fashion probably due to an impairment of extrarenal digoxin clearance.

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