Digoxin with Nitrendipine 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
Increased serum digoxin concentrations and toxicity (nausea, vomiting, arrhythmias); increased risk of complete heart block
Interaction Summary
Concomitant use of digoxin and nitrendipine increased digoxin serum concentrations and AUC by 57% and 15%, respectively, 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 digoxin dose. Concentrations may be reduced if required by reducing the digoxin dose by approximately 30% to 50% 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 nitrendipine 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 30% to 50% or by modifying the dosing frequency. Continue monitoring digoxin plasma concentration.
Mechanism Of Interaction
Additive effects on AV node conduction and increased digoxin exposure
Literature Reports
A) Concomitant nitrendipine 20 mg once daily and digoxin 0.5 mg twice daily given for three days, followed by digoxin 0.25 mg twice daily given an additional four days to six healthy volunteers, reportedly resulted in no significant changes in the pharmacokinetic parameters of nitrendipine. However, coadministration did result in significant increases in the digoxin plasma concentrations, from 0.96 mcg/L to 1.98 mcg/L . Two patients experienced toxic concentrations (greater than 2 mcg/L) and adverse effects, which were described as impaired sense of smell, flickering before the eyes, and inability to concentrate.
B) In another study, nitrendipine did not significantly affect digoxin pharmacokinetics . When oral nitrendipine 20 mg twice daily was administered to ten healthy volunteers given oral beta-acetyldigoxin 0.3 mg once daily (following a 0.6 mg loading dose), digoxin serum concentrations decreased only slightly and urinary digoxin excretion was not altered.
C) Concomitant administration of nitrendipine 20 mg daily and digoxin 0.25 mg twice daily was reported to result in significant increases in digoxin plasma levels and AUC in healthy volunteers . Combined therapy with nitrendipine 10 mg once daily did not produce significant increases in AUC or plasma levels of digoxin. These data suggest that monitoring of digoxin serum levels may be prudent in patients receiving nitrendipine, especially in higher doses.
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.