Digoxin with Polythiazide 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
Digitalis toxicity (nausea, vomiting, arrhythmias)
Interaction Summary
The most common cause of digitalis toxicity is concurrent use of a digitalis glycoside and a potassium-wasting diuretic. If a digitalis glycoside and a thiazide diuretic are used concurrently, the patient should be monitored for ECG signs of potassium depletion, and potassium supplementation should be considered.
Severity
Major
Onset
Delayed
Evidence
Established
How To Manage Interaction
Patients given diuretics with digitalis should be told to add rich sources of potassium to their diet or they should be given potassium supplements, even though their serum potassium level is normal. The use of combination potassium-sparing potassium-depleting diuretics is also a rational approach. You may want to include some extra potassium in your diet.
Mechanism Of Interaction
Diuretic-induced hypokalemia and hypomagnesemia enhance Na-K-ATPase inhibition by cardiac glycosides
Literature Reports
A) The incidence of digitalis intoxication in hospitalized patients varies between 8% to 35%, with mortality attributable to toxicity ranging from 3% to 21% . Twenty-four percent of 144 patients on combination therapy of digoxin plus diuretic experienced digoxin toxicity, compared to only 9% of 53 patients on digoxin alone . Other authors reported that of 88 patients intoxicated with digitalis, 69% were also on diuretics (30 on chlorothiazide) . One author found that 19 of 25 (75%) patients with digitalis toxicity were also on diuretics . Another study concludes that diuretic therapy was thought to be a primary or contributory factor in precipitating digitalis intoxication in 40% of patients showing adverse reactions . The thiazides have the potential of producing hypokalemia in a large number of patients. It has been demonstrated that 40% of patients treated for more than one week with chlorothiazide and without a potassium supplement will develop hypokalemia (serum potassium of 3.5 mEq/L or less) . Because intracellular potassium may be reduced, even though the serum potassium is normal or even elevated, electrocardiographic signs of potassium depletion may be of greater value than serum potassium levels .
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.