Digoxin with Frangula 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
Hypokalemia leading to digoxin toxicity
Interaction Summary
Buckthorn bark or berry acts as a stimulant laxative. Buckthorn is noted in the German Commission E Monograph to be associated with a loss of potassium. As with other plant anthranoid laxative sources, loss of potassium can occur secondary to excessive or prolonged use, termed "laxative abuse" . Potassium loss is partly due to direct loss in the feces and partly as secondary renal effect associated with sodium loss . Patients taking buckthorn bark or berry for more than 1 to 2 weeks may experience hypokalemia (signs and symptoms include lethargy, muscle cramps, headaches, paresthesias, tetany, peripheral edema, polyuria, breathlessness, and hypertension). Patients also taking digoxin are predisposed to signs and symptoms of digoxin toxicity, including anorexia, nausea, vomiting, diarrhea, weakness, visual disturbances, and ventricular tachycardia). Concomitant use should be avoided.
Severity
Moderate
Onset
Delayed
Evidence
Theoretical
How To Manage Interaction
Patients who are taking digoxin should be advised to avoid concomitant use with buckthorn bark or berry. If digoxin toxicity occurs, potassium should be monitored and supplemented if necessary while discontinuing buckthorn bark or berry.
Mechanism Of Interaction
Laxative effect of buckthorn bark or berry
Literature Reports
A) Laxative abuse using plants such as buckthorn bark or berry that contain anthraquinone glycosides can lead to depletion of 25-50% of potassium due to water and electrolyte losses .
B) Diuretic and digoxin maintenance therapy in 12 congestive heart failure patients who were studied for hypokalemia and cardiac arrhythmias resulted in digoxin toxicity in 6 patients with normal serum digoxin levels. The daily dose of digoxin was 0.30 +/- 0.06 milligrams (mg) orally, and the mean serum concentration was 1.52 +/- 0.17 nanomoles/milliliter (nmol/mL). The mean serum potassium level was 3.41 +/- 0.09 millimoles/liter (mmol/L) for the 12 subjects .
C) Of 79 men with arrhythmias associated with digoxin intoxication, 24 were hypokalemic and 55 were normokalemic. In the hypokalemic group, mean serum potassium was 3 milliequivalents/liter (mEq/L) and mean serum digoxin level was 1.1 ng/mL compared to 4.7 mEq/L potassium and 3.7 ng/mL digoxin in the normokalemic group .
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.