Digoxin with Propafenone Interaction Details
Brand Names Associated with Digoxin
- Cardoxin®
- Digitek®
- Digoxin
- Lanoxicaps®
- Lanoxin®
Brand Names Associated with Propafenone
- Propafenone
- Rythmol®
- Rythmol® SR
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Jan 08, 2024
Interaction Effect
Digoxin toxicity (nausea, vomiting, cardiac arrhythmias)
Interaction Summary
Coadministration of digoxin and propafenone may increase digoxin serum concentrations. Measure digoxin concentrations prior to initiation of concurrent use. Reduce the oral digoxin dose by approximately 30% to 50% or the IV or IM digoxin dose by approximately 15% to 30% , or modify the dosing frequency. Continue monitoring digoxin plasma concentration levels . In children, this interaction has been somewhat more variable .
Severity
Major
Onset
Unspecified
Evidence
Probable
How To Manage Interaction
Coadministration of digoxin and propafenone may increase digoxin serum concentrations. Measure digoxin concentrations prior to initiation of concurrent use. Reduce the oral digoxin dose by approximately 30% to 50% or the IV or IM digoxin dose by approximately 15% to 30% , or modify the dosing frequency. Continue monitoring digoxin plasma concentration levels .
Mechanism Of Interaction
Unknown
Literature Reports
A) During pharmacokinetic studies, coadministration of oral digoxin and propafenone resulted in a 60% to 270% increase in digoxin AUC and a 35% to 85% increase in digoxin serum concentrations . Similarly, coadministration of IV/IM digoxin and propafenone resulted in a 28% increase in digoxin serum concentrations and a 29% increase in digoxin AUC .
B) Concomitant administration of oral propafenone and intravenous digoxin resulted in an increase in the area under the plasma concentration-time curve (AUC) and a decrease in the clearance of digoxin. In this study, six male volunteers were administered intravenous digoxin 1 mg alone, then the same dose after pretreatment with propafenone 150 mg orally every eight hours for seven days; intravenous digoxin 1 mg was also administered after propafenone 300 mg orally every eight hours for seven days. The total body clearance of digoxin decreased in a dose-related fashion, from 2.45 mL/min/kg on digoxin alone to 2.17 mL/min/kg after pretreatment with the lower dose of propafenone for seven days, and then to 1.92 mL/min/kg after pretreatment with the higher dose of propafenone. Propafenone serum levels increased by 2.5-fold after increasing the daily dose from 150 mg every eight hours to 300 mg every eight hours. There was a trend towards a decrease in the volume of distribution (Vd) of digoxin and a decrease in non-renal clearance during combined therapy, with decreases being more significant with the higher dose of propafenone. It was suggested that the mechanism of the interaction is related to decreases in the Vd and non-renal elimination of digoxin. This trial suggests that monitoring of digoxin serum levels are indicated during concomitant propafenone therapy, especially with higher doses of propafenone. In addition, as the interaction is dose-related, digoxin serum levels should be monitored closely when doses of propafenone are increased .
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.
Propafenone Overview
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Propafenone is used to treat arrhythmia (irregular heartbeat) and to maintain a normal heart rate. Propafenone is in a class of medications called antiarrhythmics. It works by acting on the heart muscle to improve the heart's rhythm.
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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.