You are more likely to have this condition if you take digoxin, digitoxin, or other digitalis medicines along with drugs that interact with it. Some of these drugs are
quinidine, flecainide, verapamil, and amiodarone
. If your kidneys do not work well, digitalis can build up in your body.
What drugs increase digoxin levels?
Erythromycin, clarithromycin, and tetracyclines
– May increase digoxin levels. Propafenone – Increases digoxin level; effects are variable. Quinidine – Increases digoxin level substantially but clinical effect is variable; related drugs, such as hydroxychloroquine and quinine, may also affect levels.
What can affect digoxin levels?
Taking digoxin within 6 to 12 hours before your test can also affect your result. Some prescription, over-the-counter, and supplemental drugs can affect the level of digoxin in your body, making it either too high or too low. These include:
antibiotics
.
What drugs should digoxin patients avoid?
The adverse effects of digoxin are potentiated by renal impairment, which may be pre-existing or due to nephrotoxic drugs such as
nonsteroidal antiinflammatory drugs (NSAIDs)
, angiotensin-converting-enzyme (ACE) inhibitors, angiotensin II receptor antagonists and ciclosporin.
What worsens digoxin toxicity?
In states of
hypokalemia
, or low potassium, digoxin toxicity is actually worsened because digoxin normally binds to the ATPase pump on the same site as potassium. When potassium levels are low, digoxin can more easily bind to the ATPase pump, exerting the inhibitory effects.
What is the most common side effect of digoxin?
Common side effects include
feeling confused, dizzy, feeling or being sick, loss of appetite
, diarrhoea, changes in your vision or skin rashes. Digoxin is usually recommended with other heart medicines when these medicines have not been enough to control your symptoms on their own.
What is the antidote for digoxin?
In the case of severe digoxin intoxication, an antidote digoxin immune Fab (
Digibind
) is available. Digibind binds and inactivates digoxin.
How often should digoxin level be checked?
Ten days
was chosen as appropriate timing to measure digoxin levels after initiation of therapy or dosage adjustment because steady state is reached in patients after 4 to 5 elimination half-lives of digoxin.
What should I be worried about digoxin?
- Tiredness.
- Nausea.
- Stomach pain.
- Loss of appetite.
- Vomiting.
- Vision problems.
- Irregular heart rate
What happens if digoxin levels are too high?
Digoxin toxicity can emerge during long-term therapy as well as after an overdose. It can occur even when the serum digoxin concentration is within the therapeutic range. Toxicity causes
anorexia, nausea, vomiting and neurological symptoms
. It can also trigger fatal arrhythmias.
Does digoxin cause more harm than good?
Overall, a meta-analysis of 11 observational studies by Ouyang et al (2015), including the AFFIRM Trial and TREAT-AF studies, found
digoxin use was associated with greater risk for mortality in patients with AF
, regardless of concomitant heart failure.
Why is digoxin not used?
The use of digoxin is
limited because the drug has a narrow therapeutic index and requires close monitoring
. Digoxin can cause many adverse events, is involved in multiple drug interactions, and can result in toxicity. Despite its limitations, however, digoxin has a place in therapy.
When should you not take digoxin?
For people with
ventricular fibrillation
: Digoxin can’t be used if you have ventricular fibrillation. It may make your ventricular fibrillation worse. For people with Wolff-Parkinson-White syndrome: If you have Wolff-Parkinson-White syndrome, you’re at a higher risk for an abnormal heart rhythm.
How do you reverse digoxin toxicity?
Digoxin-specific antibody antigen-binding fragments (DSFab), brand name Digibind or Digifab
, are an effective antidote that directly binds digoxin. DSFab is indicated for life-threatening toxicity including: Ventricular arrhythmias. High-grade heart blocks.
What increases digoxin toxicity?
A low level of potassium in the body
can increase the risk of digitalis toxicity. Digitalis toxicity may also develop in people who take digoxin and have a low level of magnesium in their body.
What are signs of digitalis toxicity?
Signs and symptoms of acute digitalis (digoxin or digitoxin) poisoning by ingestion include primarily
gastrointestinal effects (nausea and vomiting)
, hyperkalemia, and cardiovascular effects (bradydysrhythmias [heart rate <60 or atrioventricular block] or tachydysrhythmias [ventricular tachycardia/fibrillation or …
