Suitability of digoxin as a P-glycoprotein probe: Implications of other transporters on sensitivity and specificity

Authors

  • Ahmed M. Nader PhD,

    1. Pharmaceutical Sciences Section, College of Pharmacy, Qatar University, Doha, Qatar
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  • David R. Foster PharmD, FCCP

    Corresponding author
    1. Department of Pharmacy Practice, College of Pharmacy, Purdue University, Indianapolis and West Lafayette, IN, USA
    2. Department of Medicine, School of Medicine, Indiana University, Indianapolis, IN, USA
    • Corresponding Author:

      David R. Foster, PharmD, FCCP, Department of Pharmacy Practice, College of Pharmacy, Purdue University, FTB Faculty Office Building, 640 Eskenazi Avenue, Indianapolis, IN 46032.

      Email: drfoster@purdue.edu

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  • Author contributions: Ahmed M. Nader conducted search, analyzed data, and wrote manuscript. David R. Foster Analyzed data and wrote manuscript.

Abstract

The study of transporter-mediated drug–drug interactions (DDI) requires use of appropriate probes to reflect transporter function. Digoxin is often used as a probe in DDI studies involving P-glycoprotein (P-gp) and is recommended by FDA for this purpose, despite several lingering questions regarding suitability of digoxin as P-gp probe. This review aims to critically evaluate use of digoxin as a probe for P-gp-mediated clinical DDI studies, with focus on sensitivity and specificity of digoxin for P-gp. Although previous reviews have evaluated digoxin transport by P-gp, the purpose of the current review is to critically evaluate such literature in light of newly evolving literature suggesting digoxin transport by non-P-gp transporters.

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