Digoxin with Metoclopramide Interaction Details
Brand Names Associated with Digoxin
- Cardoxin®
- Digitek®
- Digoxin
- Lanoxicaps®
- Lanoxin®
Brand Names Associated with Metoclopramide
- Clopra®
- Maxolon®
- Metoclopramide
- Metozolv® ODT
- Reglan®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Jan 08, 2024
Interaction Effect
Decreased digoxin levels
Interaction Summary
Coadministration of digoxin and metoclopramide may decrease digoxin plasma concentrations due to increased gastrointestinal motility caused by metoclopramide resulting in decreased digoxin absorption. Monitor for decreased therapeutic effect of digoxin . Measure digoxin concentrations prior to initiation of concurrent use. Increase the digoxin dose (by approximately 20% to 40% with oral preparations), if necessary, and continue monitoring digoxin plasma concentration levels .
Severity
Major
Onset
Unspecified
Evidence
Probable
How To Manage Interaction
Coadministration of digoxin and metoclopramide may decrease digoxin plasma concentrations due to increased gastrointestinal motility caused by metoclopramide resulting in decreased digoxin absorption. Monitor for decreased therapeutic effect of digoxin. Measure digoxin concentrations prior to initiation of concurrent use. Increase the digoxin dose (by approximately 20% to 40% with oral preparations), if necessary, and continue monitoring digoxin plasma concentration levels .
Mechanism Of Interaction
Decreased gastrointestinal absorption
Literature Reports
A) Serum digoxin levels with or without metoclopramide were analyzed in 11 elderly women on maintenance digoxin therapy. Metoclopramide 10 mg three times daily was orally administered for 10 days resulting in a decrease in serum digoxin concentrations from initial levels of 0.72 nanogram/mL (ng/mL; 0.922 nanomol/L) to 0.46 ng/mL (0.589 nanomol/L). Withdrawal of metoclopramide resulted in a rise to normal levels over a period of 10 days. These changes are most likely a result of changes in gastrointestinal motility secondary to metoclopramide .
B) Significant reductions in the peak plasma concentration of digoxin (from 1.5 to 1.1 nanogram/mL or 1.92 to 1.41 nanomol/L) in healthy volunteers was reported following concomitant administration of metoclopramide 10 mg twice daily and digoxin 0.25 mg twice daily. Metoclopramide was also demonstrated to prolong the time to reach peak digoxin concentrations (from 2 to 2.7 hours), and reduced the digoxin area under the concentration-time curve (AUC) by 19% .
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.
Metoclopramide Overview
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Metoclopramide is used to relieve heartburn and speed the healing of ulcers and sores in the esophagus (tube that connects the mouth to the stomach) in people who have gastroesophageal reflux disease (GERD; condition in which backward flow of acid from the stomach causes heartburn and injury of the esophagus) that did not get better with other treatments. Metoclopramide is also used to relieve symptoms caused by slow stomach emptying in people who have diabetes. These symptoms include nausea, vomiting, heartburn, loss of appetite, and feeling of fullness that lasts long after meals. Metoclopramide is in a class of medications called prokinetic agents. It works by speeding the movement of food through the stomach and intestines.
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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.