Trazodone with Digoxin Interaction Details
Brand Names Associated with Trazodone
- Desyrel®
- Oleptro®
- Trazodone
- Trialodine®
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 serum concentrations and an increased risk of digoxin toxicity (nausea, vomiting, arrhythmias)
Interaction Summary
Digoxin maximum serum concentrations were increased nearly 30% compared with baseline after nefazodone (an antidepressant structurally related to traZODone) was given concurrently, in an open, randomized, crossover interaction study. Digoxin toxicity occurred in a 68-year-old woman after traZODone was added to a stable treatment regimen that included digoxin. Her digoxin level had remained within a stable therapeutic range for many months prior to beginning traZODone therapy . Increased serum digoxin serum concentrations have also been reported in patients treated concurrently with traZODone and digoxin .
Severity
Moderate
Onset
Delayed
Evidence
Probable
How To Manage Interaction
Monitor digoxin concentrations when traZODone is added to, changed during, or discontinued from concomitant treatment with digoxin. Also, monitor patients for signs and symptoms of digoxin toxicity. Adjust digoxin dose accordingly.
Mechanism Of Interaction
Unknown
Literature Reports
A) Digoxin serum concentrations were increased nearly 30% compared with baseline after nefazodone (a phenylpiperazine antidepressant structurally related to traZODone) was given concurrently with digoxin. In an open, randomized, triple-crossover interaction study, healthy subjects (n=18) received an 8-day oral regimen of digoxin 0.2 milligrams (mg) daily, nefazodone 200 mg twice daily, or both drugs administered concomitantly during each 8-day trial period; all subjects crossed over to an alternate study regimen after a 10-day wash-out period. Steady-state area under the concentration-time curve (AUC) and peak (Cmax) and trough (Cmin) serum concentrations of digoxin were increased by 15%, 29% and 27%, respectively (p less than 0.05, each parameter). No significant changes were observed in vital signs, heart rate, or PR, QRS, and QT intervals. The frequency and severity of adverse events did not differ between treatment groups .
B) Digoxin toxicity occurred in a 68-year-old woman after traZODone was added to a stable treatment regimen that included digoxin. Prior to beginning traZODone therapy, her serum digoxin level had remained within therapeutic range for many months (at a dose of digoxin 125 micrograms (mcg) daily), and on admission was 0.8 nanograms/mL (1 nanomol/L). She was hospitalized for severe depression; traZODone was initiated at a dose of 50 milligrams (mg) on day 1, and then escalated to 300 mg daily by day 11. On treatment day 14, the patient complained of nausea and vomiting; her digoxin level measured at 2.8 nanograms/mL (3.6 nanomol/L). TraZODone 300 mg daily was continued and digoxin was withdrawn until therapeutic digoxin serum levels were restored. The patient's digoxin levels were sustained within therapeutic range after conversion to an every-other-day regimen of digoxin 125 mcg while she continued to receive traZODone 300 mg daily .
C) Increased serum concentrations of digoxin have been observed in patients receiving concurrent treatment with traZODone .
Trazodone Overview
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Trazodone is used to treat depression. Trazodone is in a class of medications called serotonin modulators. It works by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance.
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.