Digoxin with Nisoldipine Interaction Details
Brand Names Associated with Digoxin
- Cardoxin®
- Digitek®
- Digoxin
- Lanoxicaps®
- Lanoxin®
Brand Names Associated with Nisoldipine
- Nisoldipine
- Sular®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Jan 08, 2024
Interaction Effect
Increased risk of complete heart block
Interaction Summary
Coadministration of digoxin and nisoldipine may have additive effects on AV node conduction and increase the risk of bradycardia and advanced or complete heart block. Caution is recommended if concomitant use is required.
Severity
Major
Onset
Rapid
Evidence
Theoretical
How To Manage Interaction
Coadministration of digoxin and nisoldipine may have additive effects on AV node conduction and increase the risk of bradycardia and advanced or complete heart block. Caution is recommended if concomitant use is required.
Mechanism Of Interaction
Additive effects on AV node conduction
Literature Reports
A) Concomitant administration of digoxin 0.25 mg twice daily and nisoldipine 10 mg twice daily has been reported to result in significant increases in plasma concentrations of digoxin in patients with heart failure . The mechanism of this interaction is unclear. It does not appear to involve an effect of nisoldipine on digoxin renal clearance .
B) The results of a double-blind, placebo-controlled study of concurrent treatment with nisoldipine and digoxin were reported. Nine patients with heart failure were treated for at least two weeks with digoxin 0.25 mg twice daily, followed by one week of either digoxin plus placebo (D+P) or digoxin plus nisoldipine 10 mg twice daily (D+N). An increase in digoxin trough levels was seen on day 7 in D+N (0.98 +/- 0.15 nanogram/mL (ng/mL) or 1.255 +/- 0.192 nanomol/L vs 1.3 +/- 0.21 ng/mL or 1.66 +/- 0.269 nanomol/L; P less than 0.05) compared with D+P. Mean digoxin plasma levels for days 5, 6, and 7 were higher with D+N (1.16 +/- 1.4 mg/mL or 1.485 +/- 1.79 mmol/L vs 1.35 +/- 0.14 mg/mL or 1.729 +/- 0.179 mmol/L; P less than 0.02) compared with D+P. Eight hours after coadministration of D+N, the pre-ejection period was shortened from 139 +/- 11 with D+P to 129 +/- 11 milliseconds (P less than 0.05), but this may have been due to the action of nisoldipine alone. No adverse effects from the increased digoxin levels were seen in the patients in this study, but some patients may experience clinical effects from this interaction .
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.
Nisoldipine Overview
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Nisoldipine is used to treat high blood pressure. Nisoldipine is in a class of medications called calcium channel blockers. It works by relaxing your blood vessels so your heart does not have to pump as hard.
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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.