Digoxin with Aluminum Hydroxide Interaction Details
Brand Names Associated with Digoxin
- Cardoxin®
- Digitek®
- Digoxin
- Lanoxicaps®
- Lanoxin®
Brand Names Associated with Aluminum Hydroxide
- AlternaGEL®
- Alu-Cap®
- Alu-Tab®
- Aluminum Hydroxide
- Amphojel®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Jan 08, 2024
Interaction Effect
Decreased digoxin levels
Interaction Summary
Coadministration of oral digoxin and antacids 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 levels.
Severity
Major
Onset
Rapid
Evidence
Theoretical
How To Manage Interaction
Coadministration of oral digoxin and antacids 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 levels.
Mechanism Of Interaction
Decreased digoxin absorption
Literature Reports
A) A randomized, single-dose, 6-way, crossover study with 12 fasting volunteers was conducted. Digoxin (capsules or tablets) 0.4 mg was administered with 60 mL of water, 60 mL of aluminum and magnesium hydroxide containing antacid, or 60 mL of kaolin-pectin. When compared with the control, the administration of both digoxin capsules or tablets with the antacid or the kaolin-pectin formulation reduced the peak plasma levels of digoxin, but did not significantly alter the time to peak. Neither the antacid or kaolin-pectin affected the plasma versus time concentration curve (AUC) of digoxin capsules or tablets .
B) Ten normal adult volunteers without cardiac, renal, gastrointestinal abnormalities, received 0.75 mg digoxin at a control time and also 60 mL of aluminum hydroxide, magnesium hydroxide or magnesium trisilicate containing antacids or kaolin-pectin at varying times. Urinary and serum digoxin samples were obtained at various times throughout a 5-day period. Bioavailability was based on an 8-hour serum digoxin concentration curve and 6 day cumulative urinary excretion of digoxin. Kaolin-pectin and magnesium trisilicate reduced the peak serum digoxin level 50% (from approximately 2.2 nanograms/mL to 1.1 nanograms/mL). Serum digoxin levels with magnesium hydroxide and aluminum hydroxide were also lower than control and were about the same as the kaolin-pectin and magnesium trisilicate doses. Mean plasma versus time concentration curve for digoxin (total absorption) for the control doses was 559 mg/min/mL, whereas it was 414 for aluminum hydroxide, 418 for magnesium hydroxide, 349 for magnesium trisilicate and 329 for kaolin-pectin. Only the magnesium trisilicate and kaolin-pectin area under the curve was significantly different from the control. The 6-day urinary excretions for the 3 antacids and kaolin-pectin were significantly different when compared to control .
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.
Aluminum Hydroxide Overview
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Aluminum hydroxide is used for the relief of heartburn, sour stomach, and peptic ulcer pain and to promote the healing of peptic ulcers.
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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.