Digoxin with Acarbose Interaction Details
Brand Names Associated with Digoxin
- Cardoxin®
- Digitek®
- Digoxin
- Lanoxicaps®
- Lanoxin®
Brand Names Associated with Acarbose
- Acarbose
- Prandase®
- Precose®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Jan 08, 2024
Interaction Effect
Decreased digoxin efficacy
Interaction Summary
Coadministration of acarbose and oral digoxin may decrease digoxin plasma concentrations. AUC and Cmax of digoxin were significantly decreased in the presence of acarbose in 1 study and case reports have described subtherapeutic levels of digoxin after acarbose was added to a regimen . Measure digoxin concentrations prior to initiation of concurrent use. Increase the digoxin dose by approximately 20% to 40%, if necessary, and continue monitoring digoxin plasma concentration levels .
Severity
Major
Onset
Unspecified
Evidence
Probable
How To Manage Interaction
Coadministration of acarbose and oral digoxin may decrease digoxin plasma concentrations. Measure digoxin concentrations prior to initiation of concurrent use. Increase the digoxin dose by approximately 20% to 40%, if necessary, and continue monitoring digoxin plasma concentration.
Mechanism Of Interaction
Decreased digoxin absorption
Literature Reports
A) A 69-year old woman with hypertension, unstable angina, congestive heart failure, and insulin-dependent diabetes was treated with several drugs including digoxin. The patient received digoxin 0.25 mg daily in addition to commonly recommended dosages of several other drugs. After the addition of acarbose to the patient's regimen, digoxin levels were measured to be subtherapeutic, at 0.48 ng/mL. After noncompliance was investigated and then ruled out as the causative factor, the digoxin dose was increased by 0.125 mg two times a week in addition to the daily dose of 0.25 mg. The next measured digoxin level was again subtherapeutic at 0.64 ng/mL. After discontinuation of acarbose for ten days, and resumption of digoxin therapy at 0.25 mg daily, measured levels of digoxin were 1.90 ng/mL (normal range: 0.8 to 2.1 ng/mL). After ruling out interactions with the patient's other medications, the authors speculated that the subtherapeutic levels of digoxin could be due to an interaction with acarbose through an unknown mechanism .
B) Seven healthy male volunteers participated in a randomized, crossover study to determine the effect of acarbose on the pharmacokinetic parameters of digoxin. In phase 1, participants received a single oral dose of digoxin 0.5 mg. Phase 2 consisted of administering a 0.5 mg dose of digoxin 30 minutes after acarbose 200 mg. During phase 3, subjects were given acarbose 100 mg three times daily for three days, and on the fourth day they received a digoxin 0.5 mg dose after the acarbose dose. During phase 2, the maximum concentration (Cmax) of digoxin decreased approximately 30% (1.99 ng/mL vs. 1.43 ng/mL) while the bioavailability was reduced by 40%. Even though the dose of acarbose in phase 3 was half of the dose in phase 2, the Cmax of digoxin was less (1.22 ng/mL) than in phase 2. The area under the concentration-time curve (AUC) from 0 to 48 hours was also reduced in phases 2 and 3 from 22.3 ng/hr/mL to 13.6 ng/hr/mL and 12.8 ng/hr/mL, respectively. These findings suggest that acarbose inhibits the absorption of digoxin from the gastrointestinal tract .
C) Two patients experienced subtherapeutic digoxin levels when acarbose was added to their drug regimen. Patient 1, a 50-year-old male, was stabilized on digoxin when acarbose 50 mg three times daily was initiated. Three months later, he presented to the emergency room with rapid atrial fibrillation. His digoxin level at that time was 0.23 ng/mL. Acarbose was discontinued for seven days, and his digoxin dose remained at 0.25 mg daily. The digoxin level increased back to a therapeutic level (1.6 ng/mL). To test the hypothesis that acarbose was the offending agent, acarbose was reinstated, and the patient's digoxin level decreased to 0.76 ng/mL. The second patient, a 72-year-old female, was started on acarbose 100 mg twice daily. Her digoxin plasma levels were subtherapeutic on two different occasions, ranging from 0.56 ng/mL to 0.72 ng/mL. Following the discontinuation of digoxin, her plasma level increased to 1.9 ng/mL .
Digoxin Overview
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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.
Acarbose Overview
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Acarbose is used (with diet only or diet and other medications) to treat type 2 diabetes (condition in which the body does not use insulin normally and therefore cannot control the amount of sugar in the blood) . Acarbose works by slowing the action of certain chemicals that break down food to release glucose (sugar) into your blood. Slowing food digestion helps keep blood glucose from rising very high after meals.
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Over time, people who have diabetes and high blood sugar can develop serious or life-threatening complications, including heart disease, stroke, kidney problems, nerve damage, and eye problems. Taking medication(s), making lifestyle changes (e.g., diet, exercise, quitting smoking), and regularly checking your blood sugar may help to manage your diabetes and improve your health. This therapy may also decrease your chances of having a heart attack, stroke, or other diabetes-related complications such as kidney failure, nerve damage (numb, cold legs or feet; decreased sexual ability in men and women), eye problems, including changes or loss of vision, or gum disease. Your doctor and other healthcare providers will talk to you about the best way to manage your diabetes.
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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.