Digoxin with Succinylcholine 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
An increased risk of cardiac arrhythmias
Interaction Summary
Concomitant digoxin and succinylcholine therapy has been reported to result in cardiac arrhythmias. This interaction is presumably due to exacerbation of digitalis-induced ventricular irritability and effects on conduction, and/or shifts of potassium from inside muscle cells to the outside of the digitalized myocardium. An effect on cholinergic receptors resulting in release of catecholamines has also been postulated.
Severity
Major
Onset
Rapid
Evidence
Theoretical
How To Manage Interaction
Cardiac rhythm should be closely monitored when administering succinylcholine to a digitalized patient.
Mechanism Of Interaction
Exacerbation of digitalis-induced ventricular irritability and/or shifts of intracellular potassium
Literature Reports
A) A digitalized 63-year-old female developed ventricular arrhythmias following repeated doses of succinylcholine. A total of 160 mg of succinylcholine had been administered when the patient developed ventricular fibrillation and cyanosis. After approximately 30 seconds, sinus rhythm returned. This patient had a history of myocardial infarction, and had also developed an atrial fibrillation following a calcium infusion test two days prior to the administration of succinylcholine .
B) The incidence of arrhythmias in digitalized patients who received either succinylcholine or pancuronium were compared. They divided 104 patients into four groups: Groups 1 and 2 were not receiving digitalis therapy, and Groups 3 and 4 were maintained on digoxin, diuretic therapy, and potassium supplementation. Patients in Groups 1 and 3 received succinylcholine 2 mg/kg while Groups 2 and 4 were administered pancuronium 0.12 mg/kg. Results showed that the incidence of dysrhythmias was significantly higher in the Group 4 patients who were receiving digoxin and pancuronium (6 out of 18 patients) than in Group 3, who received digoxin and succinylcholine (3 out of 46 patients). Additionally, there was no significant difference in the incidence of dysrhythmias following the administration of succinylcholine in digitalized or non-digitalized patients. The authors concluded that succinylcholine need not be withheld in patients on digitalis therapy, and that caution should be exercised when administering succinylcholine and pancuronium to digitalized patients .
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.