The most important organ and associated transporter involved in the clearance of digoxin are:[Fill in the blank]

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The question asks for the most important organ and associated transporter involved in the clearance of digoxin. This requires evaluating the organ responsible for digoxin clearance and the transporter that mediates its movement.
Option a: Liver/organic anion transporting polypeptide. Digoxin is not primarily cleared by hepatic uptake via OATP transporters; its renal clearance is more prominent. This makes this choice unlikely as the primary mechanism.
Option b: Liver/multidrug resistance-associated protein. MRP (MRP family) transporters are involved in efflux of various drugs, but for digoxin the key clearance pathway is not dominated by hepatic MRP activity. Thus this option mislabels the main organ and transporter.
Option c: Kidney/organic anion transporter. While the kidney is important for excretion of many drugs and organic anion transporters (OATs) can participate in drug handling, digoxin clearance is more strongly associated with active secretion via P-glycoprotein rather than a primary role for organic anion transporters alone. This makes the pairing inaccurate for the strongest mechanism.
Option d: Kidney/P-glycoprotein. Digoxin is a substrate cleared predominantly by renal excretion, and P-glycoprotein (P-gp, an efflux transporter) in the renal tubules plays a crucial role in secreting digoxin into the tubular lumen for elimination. This pairing correctly identifies the kidney as the principal organ and P-glycoprotein as the key transporter involved in its clearance.
In summary, the question pairs organ and transporter, and the combination that aligns with known pharmacokinetic clearance pathways for digoxin is the kidney with P-glycoprotein, reflecting renal secretion mediated by P-gp. The other options either misidentify the primary organ involved in clearance or assign an incorrect transporter to digoxin handling.

The most important organ and associated transporter involved in the clearance of digoxin are:[Fill in the blank]

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