Digoxin with Nefazodone Interaction Details
Brand Names Associated with Digoxin
- Cardoxin®
- Digitek®
- Digoxin
- Lanoxicaps®
- Lanoxin®
Brand Names Associated with Nefazodone
- Nefazodone
- Serzone®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Jan 08, 2024
Interaction Effect
An increase in digoxin serum concentrations and possible increase in the risk of digoxin toxicity (nausea, vomiting, cardiac arrhythmias)
Interaction Summary
Coadministration of digoxin and nefazodone may increase digoxin plasma concentration and exposure resulting in an increased risk of adverse cardiac or gastrointestinal effects . Measure digoxin concentrations prior to initiation of concurrent use. Reduce digoxin concentrations by reducing the digoxin dose (by approximately 15% to 30% with oral preparations) or by modifying the dosing frequency. Continue monitoring digoxin plasma concentration levels .
Severity
Major
Onset
Unspecified
Evidence
Established
How To Manage Interaction
Coadministration of digoxin and nefazodone may increase digoxin plasma concentrations and exposure. Measure digoxin concentrations prior to initiation of concurrent use. Reduce digoxin concentrations by reducing the digoxin dose (by approximately 15% to 30% with oral preparations) or by modifying the dosing frequency. Continue monitoring digoxin plasma concentration levels.
Mechanism Of Interaction
Unknown
Literature Reports
A) In pharmacokinetic studies, coadministration of digoxin and nefazodone resulted in a 27% increase in digoxin serum concentrations and a 15% increase in digoxin AUC .
B) To assess the effect of nefazodone on the pharmacokinetic and pharmacodynamic parameters of digoxin, 18 healthy male volunteers participated in an open, randomized, multiple-dose, three-way crossover study. Volunteers received nefazodone 200 mg twice daily, digoxin 0.2 mg daily, or both during three 8-day treatment periods, with a 10-day washout period in between treatment periods. Steady-state AUC, Cmax, and Cmin concentrations of digoxin were increased by 15%, 29% and 27%, respectively. No significant changes were observed in vital signs, heart rate, or PR, QRS, and QT intervals. Because digoxin has a narrow therapeutic index, monitoring of levels and an adjustment of the digoxin dose may be necessary when given concurrently with nefazodone .
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.
Nefazodone Overview
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Nefazodone is used to treat depression. Nefazodone is in a class of medications called serotonin modulators. It works by increasing the amounts of certain natural substances in the brain that are needed to maintain mental balance.
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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.