Digoxin with Khella 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
Reduced effectiveness of digoxin
Interaction Summary
Visnadin has been identified as one of several active components of khella. This lactone has been shown to antagonize toxic effects of digitoxin in animals. While this can be used for therapeutic advantage in cases of toxicity, it is reasonable to assume that visnadin will also affect the cardiac glycosides when used in the normal dosage range. The exact mechanism of antagonistic action of visnadin on cardiac glycosides is not yet known but may be related to competitive antagonism . Visnadin increases coronary perfusion and cardiac contractile force while only slightly increasing oxygen consumption by increasing myocardial glucose reserve . Visnadin, khellin, visnagan, samadin, and dihydrosamidin (all components of khella, Ammi visnaga) are potent coronary vasodilators . Visnadin and samidin are potent cAMP-phosphodiesterase inhibitors . Caution is advised if khella and digoxin are used concomitantly. Frequent monitoring of blood digoxin levels and symptomatology is recommended.
Severity
Moderate
Onset
Rapid
Evidence
Theoretical
How To Manage Interaction
Animal data suggest that khella may counter digoxin adverse effects. While this may be used to advantage to counter digoxin toxicity, it is unknown how patients stabilized on digoxin will be affected. Patients should be closely monitored to determine if the desired pharmacologic effect of digoxin is achieved. Monitoring of blood digoxin levels is advised.
Mechanism Of Interaction
Increased coronary perfusion and cardiac contractile force, coronary vasodilation, cAMP-phosphodiesterase inhibition
Literature Reports
A) Digitoxin was administered to 10 mice by subcutaneous (SC) injection with escalating oral visnadin (khella) doses (0 to 450 milligrams/kilogram (mg/kg)). The LD50 of digitoxin was 14.4 +/- 0.48 mg/kg with no visnadin administered versus 24.4 +/- 0.78 mg/kg when coadministered with 300 mg/kg of visnadin. Digitoxin 2.5 mg/kg/day was administered SC for two days followed by 3.5 mg/kg/day until death occurred. One group of mice received digitoxin only, while the second group of 10 mice received the same digitoxin dose plus 400 mg/kg of visnadin. The control group survived for an average of 9.3 days versus the visnadin-treated group whose survival averaged 12.8 days. The mean lethal doses were 25 mg/kg and 35 mg/kg for control and visnadin-treated groups, respectively. When digitoxin 2.5 mg/kg/day was given SC alone and with 200 mg/kg oral visnadin, electrocardiograms showed that the addition of visnadin strongly reduced the digitoxin-induced bradycardia .
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.
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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.