Case Report

Omeprazole-associated Digoxin Toxicity

Authors: Cristin A. Kiley, MD, Douglas J. Cragin, MD, Bernard J. Roth, MD


Omeprazole is a commonly prescribed inhibitor of the gastric proton pump and has numerous indications in the treatment of gastrointestinal diseases. It is primarily metabolized through the CYP2C19 enzyme, a member of the P450 mixed-function oxidase group, although a minor pathway of metabolism is through CYP3A4, another P450 enzyme. Digoxin is primarily metabolized outside the P450 system, but a minor pathway of metabolism is by CYP3A4. To our knowledge, this is the first known case of digoxin toxicity associated with omeprazole. The possible pathways for such an interaction are reviewed, including increased stomach absorption, p-glycoprotein activity and interactions in the P450 system.

Key Points

* Proton pump inhibitors are widely prescribed medications without many major known side effects or drug interactions.

* Drug-drug interactions are common with medications metabolized through the P450 enzyme system.

* Patients who are taking digoxin and require proton pump inhibition to treat concurrent gastrointestinal disorders should be monitored for the potential of a drug interaction.

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