DIGOXIN Drug Interactions
Also known as: Digoxin
DIGOXIN (brand name: Digoxin) is a Cardiac Glycosides. 1 INDICATIONS & USAGE Digoxin is a cardiac glycoside indicated for: Treatment of mild to moderate heart failure in adults. (1.1) Increasing myocardial contractility in pediatric patients with heart failure. (1.2) Control of resting ventricular rate in patients with chronic atrial fibrillation in…DIGOXIN has 2 documented drug interactions in our database, including 0 contraindicated, 2 major, 0 moderate, and 0 minor interactions.
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Contraindicated
2
Major
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Moderate
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Minor
Furosemide, a loop diuretic, can cause hypokalemia and hypomagnesemia. These electrolyte imbalances significantly increase the risk of digoxin toxicity, potentially leading to severe cardiac arrhythmias and other adverse effects, even at therapeutic digoxin levels.
Mechanism
Furosemide-induced hypokalemia and hypomagnesemia enhance digoxin's binding to the Na+/K+-ATPase pump. This increased binding exacerbates the inhibitory effect of digoxin, leading to heightened intracellular calcium and subsequent toxicity.
Clinical Management
Closely monitor serum potassium, magnesium, and digoxin levels when co-administering furosemide and digoxin. Supplement potassium and/or magnesium as needed to maintain levels within the normal range to prevent digoxin toxicity. Adjust digoxin dose if necessary.
Amiodarone significantly increases digoxin serum concentrations, potentially leading to digoxin toxicity. Patients may experience symptoms such as nausea, vomiting, visual disturbances, and life-threatening arrhythmias. This interaction can occur even with previously stable digoxin doses.
Mechanism
Amiodarone inhibits P-glycoprotein (P-gp), a transporter responsible for digoxin efflux from enterocytes and renal tubular cells. This inhibition reduces digoxin's intestinal secretion and renal clearance, leading to increased systemic exposure and prolonged half-life.
Clinical Management
When initiating amiodarone in a patient on digoxin, the digoxin dose should be reduced by 30-50% (or even discontinued temporarily). Close monitoring of serum digoxin levels, renal function, and electrolytes is essential. Patients should be educated on symptoms of digoxin toxicity.
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