Digoxin with Nifedipine Interaction Details
Brand Names Associated with Digoxin
- Cardoxin®
- Digitek®
- Digoxin
- Lanoxicaps®
- Lanoxin®
Brand Names Associated with Nifedipine
- Adalat®
- Adalat® CC
- Afeditab® CR
- Nifedical® XL
- Nifedipine
- Nifeditab® CR
- Procardia®
- Procardia® XL
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Jan 08, 2024
Interaction Effect
Digoxin toxicity (nausea, vomiting, arrhythmias); increased risk of complete heart block
Interaction Summary
Coadministration of digoxin and NIFEdipine may increase digoxin plasma concentrations. Additionally, coadministration may have additive effects on AV node conduction and increase the risk of bradycardia and advanced or complete heart block. Serum concentrations of digoxin were increased by 45% in pharmacokinetic studies. Patients with higher pre-existing serum digoxin concentrations are at greater risk for digitalis toxicity . Measure digoxin concentrations prior to initiation of concurrent use. Individualize the dose and if necessary, reduce digoxin concentrations by reducing the digoxin dose by approximately 15% to 30% or by modifying the dosing frequency. Continue monitoring digoxin plasma concentration .
Severity
Major
Onset
Rapid
Evidence
Theoretical
How To Manage Interaction
Coadministration of digoxin and NIFEdipine may increase digoxin plasma concentrations. Additionally, coadministration may have additive effects on AV node conduction and increase the risk of bradycardia and advanced or complete heart block. Measure digoxin concentrations prior to initiation of concurrent use. Individualize the digoxin dose. Concentrations may be reduced if required by reducing the digoxin dose by approximately 15% to 30% or by modifying the dosing frequency. Continue monitoring digoxin plasma concentration.
Mechanism Of Interaction
Additive effects on AV node conduction
Literature Reports
A) During pharmacokinetic studies, coadministration of digoxin and NIFEdipine resulted in a 45% increase in digoxin serum concentrations .
B) The effect of NIFEdipine on digoxin pharmacokinetics is controversial. Some have found steady-state digoxin concentrations to increase up to 50% following NIFEdipine, however, these results have not been confirmed by other studies . Based upon a review of the literature, it is suggested that steady-state digoxin levels may increase from 24% to 45% when NIFEdipine is added to therapy, but that adverse effects have not been observed in patients studied . It is suggested that, with current available data, it is not possible to recommend routine alterations in digoxin dosage with NIFEdipine therapy. It is felt that the interaction is of minimal significance in most patients, but that digoxin serum level monitoring is warranted.
C) The effect of NIFEdipine 10 mg orally three times daily titrated to clinical response or tolerance on serum digoxin concentrations in 14 cardiac patients was evaluated. Patients had steady-state digoxin levels prior to entering the study and were allowed to continue concomitant medications which consisted primarily of long-acting nitrates, beta-blockers, and diuretics. The mean trough digoxin level was 0.78 nanogram/mL (ng/mL; 0.999 nanomol/L) before NIFEdipine and 0.8 ng/mL (1.02 nanomol/L) after 1 week of combined drug therapy and 0.84 ng/mL (1.076 nanomol/L) after 2 weeks of combined drug administration. These data suggest that cardiac patients stabilized on digoxin can receive combined digoxin and NIFEdipine without significantly altering the serum digoxin concentration .
D) NIFEdipine can delay gastric emptying and may potentially be of clinical concern in geriatric patients and in patients with diabetes or those who are taking digoxin, levodopa, or penicillin .
E) No interaction was reported between NIFEdipine and digoxin in patients with coronary artery disease. Digoxin 0.5 mg was administered IV on the fourth day of treatment with NIFEdipine 10 mg six times daily. NIFEdipine had no significant effect on the half-life, volume of distribution, clearance or percentage of digoxin recovered in the urine .
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.
Nifedipine Overview
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Nifedipine is used to treat high blood pressure and to control angina (chest pain). Nifedipine is in a class of medications called calcium-channel blockers. It lowers blood pressure by relaxing the blood vessels so the heart does not have to pump as hard. It controls chest pain by increasing the supply of blood and oxygen to the heart.
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High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.
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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.