Alprazolam with Digoxin Interaction Details

Brand Names Associated with Alprazolam

  • Alprazolam
  • Niravam®
  • Xanax®
  • Xanax® XR

Brand Names Associated with Digoxin

  • Cardoxin®
  • Digitek®
  • Digoxin
  • Lanoxicaps®
  • Lanoxin®

Medical Content Editor
Last updated Feb 27, 2024

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Interaction Effect

Digoxin toxicity (nausea, vomiting, arrhythmias)

Interaction Summary

Coadministration of alprazolam and digoxin may increase serum digoxin concentrations, especially in geriatric patients (greater than 65 years). When concomitant use is required, monitor serum digoxin levels prior to initiation of alprazolam, continue monitoring digoxin levels and for signs of toxicity during treatment, and reduce the digoxin dose as required[1][2][3][4].

Severity

Major

Onset

Unspecified

Evidence

Probable

How To Manage Interaction

Coadministration of alprazolam and digoxin may increase serum digoxin concentrations, especially in geriatric patients (greater than 65 years). When concomitant use is required, monitor serum digoxin levels prior to initiation of alprazolam, continue monitoring digoxin levels and for signs of toxicity during treatment, and reduce the digoxin dose as required[1][2][3][4].

Mechanism Of Interaction

Unknown

Literature Reports

A) Concomitant administration of alprazolam 1.5 mg/day and digoxin resulted in no change in digoxin clearance or other pharmacokinetic variables for digoxin. In addition, creatinine clearance was not significantly affected during concomitant administration [5].

B) A 72-year-old nursing home female patient with atherosclerotic coronary vascular disease complicated by an anterior infarction and reversible congestive heart failure had a drug regimen which included oral isosorbide, furosemide, potassium chloride, and oral digoxin (0.25 mg every morning except Sunday). Serum digoxin concentrations ranged from 1.6 to 1.8 nanograms/mL (2 to 2.3 nanomol/L). The patient complained of insomnia, restlessness, and anxiety, and was started on alprazolam 1 mg at bedtime. During the second week of therapy, the patient had a number of non-specific complaints and was referred to the hospital. On admission, the serum digoxin concentration was 4.3 nanograms/mL (5.5 nanomol/L). The patient's serum creatinine on admission was unchanged from previous visits. Both digoxin and alprazolam were discontinued. On her third hospital day, she developed ventricular tachycardia which required lidocaine administration. Oral digoxin was restarted at 0.125 mg/day. Follow-up steady-state digoxin concentration was 1.5 nanograms/mL (1.9 nanomol/L) [6].

References

    1 ) Product Information: XANAX(R) oral tablets, alprazolam oral tablets. Pharmacia & Upjohn Co (per FDA), New York, NY, 2021.

    2 ) Product Information: Xanax(R) XR oral extended-release tablets, alprazolam oral extended-release tablets. Pharmacia & Upjohn Co (per FDA), New York, NY, 2021.

    3 ) Product Information: LANOXIN(R) oral tablets, digoxin oral tablets. Covis Pharmaceuticals, Inc. (per FDA), Cary, NC, 2013.

    4 ) Product Information: digoxin oral solution, digoxin oral solution. Roxane Laboratories, Inc. (per manufacturer), Columbus, OH, 2012.

    5 ) Ochs HR, Greenblatt DJ, & Verburg-Ochs B: Effect of alprazolam on digoxin kinetics and creatinine clearance. Clin Pharmacol Ther 1985; 38:595-598.

    6 ) Tollefson G, Lesar T, Grothe D, et al: Alprazolam-related digoxin toxicity. Am J Psychiatry 1984; 141:1612-1614.

Alprazolam Overview

  • Alprazolam is used to treat anxiety disorders and panic disorder (sudden, unexpected attacks of extreme fear and worry about these attacks). Alprazolam is in a class of medications called benzodiazepines. It works by decreasing abnormal excitement in the brain.

See More information Regarding Alprazolam

Digoxin Overview

  • Digoxin is used to treat heart failure and abnormal heart rhythms (arrhythmias). It helps the heart work better and it helps control your heart rate.

See More information Regarding Digoxin

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Definitions

Severity Categories

Contraindicated

These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.


Major

This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.


Moderate

This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.


Minor

While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.

Onset

Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.

Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.

Evidence

Level of documentation of the interaction.

Established: The interaction is documented and substantiated in peer-reviewed medical literature.

Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.

How To Manage The Interaction

Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.

It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.

Mechanism Of Interaction

The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.

Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.

Where Does Our Information Come From?

Information for our drug interactions is compiled from several drug compendia, including:

The prescribing information for each drug, as published on DailyMED, is also used. 

Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.

The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.