Digoxin with Indomethacin Interaction Details
Brand Names Associated with Digoxin
- Cardoxin®
- Digitek®
- Digoxin
- Lanoxicaps®
- Lanoxin®
Brand Names Associated with Indomethacin
- Indocin®
- Indomethacin
- Tivorbex®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Jan 08, 2024
Interaction Effect
Increased serum concentration of digoxin; prolonged half-life of digoxin
Interaction Summary
Concomitant use of digoxin and indomethacin increased digoxin serum concentrations by 40% in pharmacokinetic studies and significantly decreased urine output in premature and full-term infants . The average increase in digoxin concentrations was about 1 nanogram/mL (1.3 nanomol/L), with a digoxin half-life increase of 1.5 to 2-fold. One study of digoxin and indomethacin in adults found increased serum digoxin, although the range of increase varied widely , and a pharmacokinetic study in adults found no effect . Measure digoxin concentrations prior to initiation of concurrent use . Reduce digoxin concentrations by reducing the digoxin dose by approximately 15% to 30% or by modifying the dosing frequency. Continue monitoring digoxin plasma concentration levels .
Severity
Major
Onset
Unspecified
Evidence
Theoretical
How To Manage Interaction
Coadministration of digoxin and indomethacin may increase digoxin plasma concentrations. Measure digoxin concentrations prior to initiation of concurrent use. Reduce digoxin concentrations by reducing the digoxin dose by approximately 15% to 30% or by modifying the dosing frequency. Continue monitoring digoxin plasma concentration levels .
Mechanism Of Interaction
Decline in GFR or tubular secretion may impair excretion of digoxin
Literature Reports
A) During pharmacokinetic studies, coadministration of digoxin and indomethacin resulted in a 40% increase in digoxin serum concentrations .
B) The renal depressant effects of indomethacin contributed to increased digoxin serum levels in an 1800 gram male infant being treated for congestive heart failure caused by persistent patent ductus arteriosus .
C) A case study reported toxic levels of digoxin when indomethacin was added in a full-term neonate. In this case, serum digoxin rose to 8.2 nanogram/mL (ng/mL; 10.5 nanomol/L) with a pronounced reduction in urine output. Clinical signs of toxicity were not apparent .
D) Concomitant therapy with oral indomethacin and digoxin was reported to result in significant elevations in serum digoxin concentrations, to potentially toxic levels, in preterm infants (from 2.2 to 3.2 nanogram/mL or 2.82 to 4.1 nanomol/L). This effect was correlated with a decrease in urine output. The half-life of digoxin increased significantly (to 97 hours) following indomethacin as compared with age-matched controls (half-life 43 hours) . The authors suggest that digoxin dosages be reduced by 50% when indomethacin is added to digoxin therapy in preterm infants.
E) A study reported an increase in serum digoxin (from 0.73 +/- 0.34 to 1.02 +/- 0.43 nanomol/L) in 10 patients who were receiving chronic digoxin therapy when indomethacin 50 mg three times daily was added to their regimen. Eight patients who received concomitant ibuprofen 600 mg three times daily did not experience an alteration in steady-state serum digoxin concentration .
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.
Indomethacin Overview
-
Indomethacin is used to relieve moderate to severe pain, tenderness, swelling, and stiffness caused by osteoarthritis (arthritis caused by a breakdown of the lining of the joints), rheumatoid arthritis (arthritis caused by swelling of the lining of the joints), and ankylosing spondylitis (arthritis that mainly affects the spine). Indomethacin is also used to treat pain in the shoulder caused by bursitis (inflammation of a fluid-filled sac in the shoulder joint) and tendinitis (inflammation of the tissue that connects muscle to bone). Indomethacin immediate-release capsules and suspension (liquid) are also used to treat acute gouty arthritis (attacks of severe joint pain and swelling caused by a build-up of certain substances in the joints). Indomethacin is in a class of medications called NSAIDs. It works by stopping the body's production of a substance that causes pain, fever, and inflammation.
Return To Our Drug Interaction Homepage
Feedback, Question Or Comment About This Information?
Ask Dr. Brian Staiger, PharmD, our medical editor, directly! He's always more than happy to assist.
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.