Interaction between Digoxin and Amiodarone
Major
Distribution
| ID | DDInter554 and DDInter76 |
| Interaction |
Coadministration with amiodarone may increase serum digoxin concentrations by up to 100%, frequently resulting in clinical toxicity. In children, this percentage may be even higher. Amiodarone has been suggested to increase intestinal transit time, reduce renal clearance and volume of distribution, displace digoxin from protein binding sites, as well as induce hypothyroidism, all of which may contribute to increased serum digoxin levels. In addition, both drugs may have additive bradycardic effects. Torsade de pointes cardiac arrhythmia has been reported. The interaction also has occurred with digitoxin.
Anorexia
Arrhythmia
asthenia
AFIB
atrial flutter
Candida Infection
Diabetic Retinopathy
drug toxicity NOS
Difficulty breathing
asystole
More
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| Management | The need for continued digitalis therapy should be evaluated if amiodarone is prescribed to patients treated with digitalis. Empirical reduction of digitalis dosage by one-third to one-half should be considered in patients who require concomitant treatment with these drugs. Serum digitalis levels should be closely monitored and patients observed for clinical evidence of toxicity. Patients should be advised to seek medical attention if they experience signs of digitalis toxicity such as nausea, anorexia, visual disturbances, slow pulse, or irregular heartbeats. |
| References | |
| Alternative for Digoxin | - |
| Alternative for Amiodarone |
C01B
|
Potential Metabolism Interactions
Substrate-Substrate Interaction：If more than one drug is metabolized by the same CYP, it is possible that its metabolism is inhibited because of the competition between the drugs. That means, it can be useful to lower the dosage of the drugs in the drug-cocktail because they remain longer in the organism than in monotherapy.
Inhibitor-Inhibitor Interaction：Combining two or more inhibitors of one CYP, should be compensated by lowering the dosage of these drugs because the metabolism is reduced and the drugs remain longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.
Inhibitor-Substrate Interaction：Combining drugs that have inhibitory effect and are substrates of one particular CYP, should be compensated by lowering the dosage. They rest longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.