Avoiding Inappropriate Apixaban Dose Reduction — EECC MCQ

Correct answer: D — P-glycoprotein inhibition

Macrolides can raise digoxin exposure through P-glycoprotein inhibition and altered gut metabolism, particularly in renal impairment. Digoxin should be withheld, the rhythm, potassium and renal function assessed, and a level interpreted against timing. Severe toxicity may require digoxin-specific antibody fragments. Apply this conclusion only to the clinical circumstances stated, with appropriate specialist review, contraindication checks, shared decision-making and follow-up. Reassess if the physiology, treatment response or competing risk changes. The competing options would require a different haemodynamic profile, diagnosis, procedural indication or risk balance from the one described here.

Reference: BNF: digoxin. https://bnf.nice.org.uk/drugs/digoxin/