Digoxin
Brand names
- Digitek
- Lanoxicaps
- Lanoxin
- Novo-Digoxin
- SK-Digoxin
Usage
To treat congestive heart failure and atrial arrhythmias
(heart rhythm irregularities).
How it works
Digitalis medicaments such as digoxin
enhance and strengthen the
force of the heart's contractions, and help to regulate the
rate and the rhythm of the heartbeat.
Side effects
- Serious
- Heartbeat irregularities causing dizziness,
palpitations,
shortness of breath, sweating, or
fainting. Other serious
side effects include hallucinations, confusion, and mental
changes; extreme drowsiness; visual disturbances, such as
double vision or seeing colored halos around objects;
weakness, fatigue, blurred vision;
nausea; or agitation.
Seek medical help immediately.
- Common
- No common side effects are associated with digoxin.
- Less common
- Impotence,
headache,
vertigo,
numbness or tingling
sensation, male breast enlargement, overall feeling of illness,
sensitivity of eyes to light, diarrhea,
vomiting. Call your
doctor if such symptoms persist.
Possible interactions
- Other medicaments:
Digoxin taken concurrently with:
- acarbose (Precose) may result in decreased digoxin
blood levels and loss of digoxin's benefits.
- calcium (intravenously) may cause a fatal interaction.
- digoxin immune Fab (Digibind) will result in decreased blood levels. This is
used to therapeutic advantage in digoxin toxicity.
- diuretics (except spironolactone or
triamterene) can cause serious heart
rhythm problems due to loss of potassium.
- dofetilide (Tikosyn) has been found to result in increased occurrence of an
abnormal heart effect. Presently, it is unclear if this is an interaction or is
a result of medicines used in sicker patients. Caution is
advised.
- metformin (Glucophage) may increase metformin levels and lead to
excessively low blood sugar.
- propranolol or other beta-blocking medicines may cause
very slow heart rate.
- quinidine may result in decreased digoxin effectiveness and increased
digoxin toxicity; careful dose adjustments are needed.
- succinylcholine may lead to abnormal heart rhythms.
The following medicaments may increase the effects of digoxin:
- alprazolam (Xanax).
- amiloride (Midamor).
- amiodarone (Cordarone).
- amphotericin B (Abelcet, Fungizone).
- atorvastatin (Lipitor).
- benzodiazepines (Librium, Valium, etc.).
- captopril (Capoten, Capozide).
- cotrimoxazole (various).
- cyclosporine (Sandimmune).
- diltiazem (Cardizem) and other calcium channel blockers.
- disopyramide (Norpace).
- erythromycin (E.E.S., Erythrocin, etc.). May also occur with clarithromycin
and azithromycin.
- ethacrynic acid.
- flecainide (Tambocor).
- gatifloxacin (Tequin).
- hydroxychloroquine.
- ibuprofen (Advil, Medipren, Motrin, Nuprin, etc.).
- indomethacin (Indocin) and other NSAIDs.
- itraconazole (Sporanox).
- methimazole (Tapazole).
- mibefradil (Posicor).
- nefazodone (Serzone).
- nifedipine (Adalat, Procardia).
- omeprazole (Prilosec).
- phenytoin (Dilantin).
- propafenone (Rythmol) (30-100% increased blood level).
- propylthiouracil (Propacil).
- quinine.
- quinupristin/dalfopristin (Synercid).
- ritonavir (Norvir).
- spironolactone (Aldactone).
- tetracyclines.
- tolbutamide (Orinase).
- tramadol (Ultram).
- trazodone (Desyrel).
- trimethoprim (Septra, others).
- verapamil (Calan, Verelan, others).
The following medicaments may decrease the effects of digoxin:
- Foods:
- Talk to your doctor about high-potassium foods. The peak level and rate
that digoxin enters your body will decrease if taken with food.
- Herbal medicines or minerals:
- Hawthorn and
co-enzyme Q10 can affect the way the heart works. Be certain to tell your doctor that you are
taking or are considering taking these herbs if you are taking digoxin or if a
digoxin prescription is being considered for you or a loved one. Q10
may also interact badly with aspirin. Soy (milk, tofu, etc.) contains
phytoestrogens that have lead to an FDA approved health claim for reducing risk
of heart disease (if they have at least 6.25 grams of soy protein per serving).
It is important that potassium and
magnesium levels be kept in the normal
range while you are taking digoxin.
St. John's wort appears to lower digoxin levels by about 25%. This decrease
may lead to loss of digoxin benefits and can be a very serious medicament interaction.
Couch grass or
nettle should not be taken by patients who have
increased fluid (edema) caused by heart
weakness. Patients taking digoxin should not take
lily of the valley herb, pheasant's eye or
squill. Hawthorn
(Crataegus variety) has been used to help heart failure, but should not be
combined with heart medicines as combination use has not been studied.
Use of intravenous calcium may cause a fatal interaction with digoxin.
- Beverages:
- Avoid excessive amounts of caffeine-containing beverages or herbs:
coffee, tea, cola.
- Tobacco smoking:
- Nicotine can cause heart muscle irritability and predispose to serious
rhythm disturbances.
- Marijuana smoking:
- Possible accentuation of heart failure; reduced digoxin
effect; possible changes in electrocardiogram, confusing interpretation.
- Occurrence of unrelated illness:
- Vomiting or diarrhea can seriously alter this
medicament's effectiveness. Notify your physician promptly.
- Discontinuation:
- This medicament may be continued indefinitely. Do not stop it
without consulting your physician.
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