Omeprazole with Digoxin Interaction Details
Brand Names Associated with Omeprazole
- Omeprazole
- Prilosec®
- Prilosec® OTC
- Talicia (as a combination product containing Amoxicillin, Omeprazole, Rifabutin)
- Zegerid® (as a combination product containing Omeprazole, Sodium Bicarbonate)
- Zegerid® OTC (as a combination product containing Omeprazole, Sodium Bicarbonate)
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 digoxin exposure, an increased risk of digoxin toxicity (nausea, vomiting, arrhythmias) and an increased risk of hypomagnesemia
Interaction Summary
Digoxin toxicity has been described in patients receiving omeprazole concurrently. Proposed mechanisms of action include the phenotypic or age-related alterations in digoxin metabolism, or an increase in digoxin bioavailability caused by omeprazole's inhibition of gastric acid secretion . Monitor digoxin levels and for signs and symptoms of digoxin toxicity in patients requiring concomitant digoxin and omeprazole therapy. Digoxin dose adjustment may be needed to maintain therapeutic drug concentrations. Monitor magnesium levels prior to initiation of proton pump inhibitors treatment and periodically in patients on digoxin therapy. Supplement with magnesium as necessary .
Severity
Major
Onset
Rapid
Evidence
Probable
How To Manage Interaction
Digoxin toxicity has occurred in patients receiving omeprazole concurrently. Monitor digoxin levels and for signs and symptoms of digoxin toxicity in patients requiring concomitant digoxin and omeprazole therapy. Digoxin dose adjustment may be needed to maintain therapeutic drug concentrations. Monitor magnesium levels prior to initiation of proton pump inhibitors treatment and periodically in patients on digoxin therapy. Supplement with magnesium as necessary .
Mechanism Of Interaction
Increased digoxin absorption; alterations in digoxin metabolism
Literature Reports
A) Concomitant administration of omeprazole 20 mg once daily and digoxin in healthy subjects increased the bioavailability of digoxin by 10% (30% in two subjects) .
B) In a randomized, 2-way crossover study, 10 patients were given digoxin 1 mg alone. They were also given omeprazole 20 mg daily for 11 days; digoxin 1 mg was given on day 8. The AUC for digoxin increased about 10% with concomitant therapy. The net effect was minimal with respect to changes in digoxin levels and would not be clinically significant for most patients .
C) A 65-year-old Caucasian woman experienced signs of digoxin toxicity and an elevated serum digoxin level 3 months after starting omeprazole 20 mg concurrently for GERD. The patient had a history of hyperlipidemia, osteoarthritis, type 2 diabetes mellitus, recurrent nephrolithiasis, and paroxysmal atrial fibrillation, and had been stable on oral digoxin 0.625 mg daily for 6 years prior to the current presentation. Concomitant medications included meloxicam, lisinopril, raloxifene, atorvastatin, gemfibrozil, warfarin, oxybutynin, hydrochlorothiazide, and potassium citrate. Her serum digoxin level prior to starting the omeprazole was 1.1 nanogram/mL (ng/mL; 1.41 nanomol/L). She presented to the emergency department following an episode of emesis and had weakness, dysequilibrium, nausea, and altered vision. She reported experiencing yellow hazy vision 2 months prior, but denied any other neurologic symptoms and had no history of neurologic disease. Her ECG revealed bigeminy, a cardiac exam reported an irregular hear rate and a III/VI systolic ejection murmur, and her serum digoxin level was 3.9 ng/mL (4.99 nanomol/L). Her renal function was normal with serum creatinine 0.8 mg/dL (70.7 mcmol/L). She was administered digoxin antidote (digoxin immune fab) and was admitted to the ICU. Digoxin was stopped and her ECG returned to baseline within 2 days with no adverse effects. Proposed mechanisms of action include the phenotypic or age-related alterations in digoxin metabolism, or an increase in digoxin bioavailability caused by omeprazole's inhibition of gastric acid secretion .
Omeprazole Overview
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Prescription omeprazole is used alone or with other medications to treat the symptoms of gastroesophageal reflux disease (GERD), a condition in which backward flow of acid from the stomach causes heartburn and possible injury of the esophagus (the tube between the throat and stomach) in adults and children 1 year of age and older. Prescription omeprazole is used to treat damage from GERD in adults and children 1 month of age and older. Prescription omeprazole is used to allow the esophagus to heal and prevent further damage to the esophagus in adults and children 1 year of age and older with GERD. Prescription omeprazole is also used to treat conditions in which the stomach produces too much acid such as Zollinger-Ellison syndrome in adults. Prescription omeprazole is also used to treat ulcers (sores in the lining of the stomach or intestine) and it is also used with other medications to treat and prevent the return of ulcers caused by a certain type of bacteria (H. pylori) in adults. Nonprescription (over-the-counter) omeprazole is used to treat frequent heartburn (heartburn that occurs at least 2 or more days a week) in adults. Omeprazole is in a class of medications called proton-pump inhibitors. It works by decreasing the amount of acid made in the stomach.
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.