Digoxin with Chan Su Interaction Details
Brand Names Associated with Digoxin
- Cardoxin®
- Digitek®
- Digoxin
- Lanoxicaps®
- Lanoxin®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Jan 08, 2024
Interaction Effect
Increased risk of digoxin toxicity
Interaction Summary
Chan-su (toad venom toxin), a bufadienolide, is cardioactive with properties similar to digitalis. Ingestion or dermal absorption of toad venom (from Bufo species) has caused typical digitalis-like poisoning, with dysrhythmias, heart block, hypotension, and vomiting . Additionally, Chan-Su may be incorrectly detected as digoxin at levels up to 0.5 nanograms/milliliter in some assays, resulting in falsely elevated digoxin levels. Consider using testing methods less susceptible to interference, such as LC/MS/MS .
Severity
Major
Onset
Unspecified
Evidence
Theoretical
How To Manage Interaction
If Chan-Su is taken with digoxin, monitor for signs and symptoms of digoxin toxicity (e.g., nausea, vomiting, diarrhea, headache, weakness, drowsiness, visual disturbance, dysrhythmias, heart block, hypotension). Additionally, Chan-Su may be incorrectly detected as digoxin at levels up to 0.5 nanograms/milliliter in some assays, resulting in falsely elevated digoxin levels. Consider using testing methods less susceptible to interference, such as LC/MS/MS.
Mechanism Of Interaction
Additive digitalis glycoside effect
Literature Reports
A) Six previously healthy males between the ages of 17 and 40 presented with vomiting, bradycardia, and hypotension; several were hyperkalemic and 1 suffered a seizure. All exhibited positive serum digoxin concentrations. The substance they had ingested was an aphrodisiac called "love stone" or "rock hard", which was found to be identical to Chan-Su, a Chinese medication derived from toad venom. Four of the patients died of cardiac dysrhythmias. Two recovered after administration of digoxin immune Fab (Digibind(R)) .
B) A 65-year-old woman developed nausea, vomiting, diarrhea, general malaise, and abdominal pain 5 hours after consuming 50 tablets of kyushin, a traditional Chinese medicine containing Chan-Su (suicide attempt). Upon hospital admission her heart rate was 60 beats/minute, blood pressure was 140/70 mmHg. The ECG showed a second degree Wenckebach AV block and a flat T-wave which normalized the next day. The serum digoxin-like immunoreactive substance (DLIS) was 2.35 ng/mL 24 hours after ingestion (using the Digoxin II kit by Abbott Laboratories, Inc.). Serum electrolytes were normal. With supportive treatment, this gradually declined over 5 days and the patient was released on the eighth day .
C) A 34-year-old woman developed nausea, vomiting, and general malaise 2 hours after consuming approximately 50 pills of kyushin, a traditional Chinese medicine containing Chan-Su, during an attempted suicide. On admission to the hospital, her heart rate was 64 beats/minute, blood pressure was 110/70 mmHg. Serum DLIS 10 hours after consuming the drug was 1.84 ng/mL. This diminished to 0.67 ng/mL by the next day with supportive treatment and symptoms also subsided. Serum electrolytes were normal. All ECGs during hospitalization were normal .
D) The bufadienolides in toad venom (Chan-su) are presumed to be the cardioactive components of Chan-Su which has proven its ability to inhibit sodium, potassium, and ATPase activity .
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.
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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.