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Digoxin Intravenous and Isoptin SR

Determining the interaction of Digoxin Intravenous and Isoptin SR and the possibility of their joint administration.

Check result:

Digoxin Intravenous <> Isoptin SR

Relevance: 21.12.2022 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

Before taking verapamil, tell your doctor if you also use digoxin. You may need dose adjustments or special tests in order to safely take both medications together. This combination may increase digoxin levels. You should notify your doctor if you have symptoms of nausea, loss of appetite, visual changes, slow pulse, or irregular heartbeats. It is important that you tell your healthcare provider about all other medications that you are using including vitamins and herbs. Do not stop using your medications without first talking to your doctor first.

Professional:

ADJUST DOSE: Verapamil increases digoxin levels significantly in most patients. Verapamil decreases renal and extrarenal clearance of digoxin. Serum digoxin levels may increase by 50% to 75% during the first week of concomitant verapamil therapy. Increases may be larger in patients with hepatic cirrhosis. Digoxin and verapamil have additive effects in slowing AV conduction. In clinical trials with digitalized patients with atrial fibrillation or atrial flutter, 15% of patients developed ventricular rates of less than 50/min and 5% developed asymptomatic hypotension.

MANAGEMENT: If verapamil and digoxin are used together to control a supraventricular tachyarrhythmia, the dosage of each drug may have to be reduced. Despite the possible negative inotropic effects of verapamil, digoxin dosage probably will not have to be increased when a patient with congestive heart failure is given verapamil. Increased digoxin concentrations may offset the negative inotropic effects of verapamil. Patients should be closely monitored for clinical and laboratory evidence of digoxin safety and efficacy while taking verapamil and evaluated for underdigitalization when verapamil is discontinued. Patients should be advised to notify their physicians if they experience signs of toxicity such as nausea, anorexia, visual changes, slow pulse, or irregular heartbeats. Calcium channel blockers such as felodipine, or amlodipine, isradipine, and nicardipine appear to affect digoxin levels to a lesser extent or not at all and may be considered as alternatives.

References

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Kuhlmann J "Effects of verapamil, diltiazem, and nifedipine on plasma levels and renal excretion of digitoxin." Clin Pharmacol Ther 38 (1985): 667-73
Johannessen A, Rendtorff C, Poulsen S "Digoxin intoxication induced by verapamil in an uremic patient ." Clin Nephrol 24 (1985): 158-9
Gordon M, Goldenberg LM "Clinical digoxin toxicity in the aged in association with co-administered verapamil." J Am Geriatr Soc 34 (1986): 659-62
Maragno I, Gianotti C, Tropeano PF, et al "Verapamil-induced changes in digoxin kinetics in cirrhosis." Eur J Clin Pharmacol 32 (1987): 309-11
Pedersen KE, Dorph-Pedersen A, Hvidt S, Klitgaard NA, Pedersen KK "The long-term effect of verapamil on plasma digoxin concentration and renal digoxin clearance in healthy subjects." Eur J Clin Pharmacol 22 (1982): 123-7
Ito S, Woodland C, Harper PA, Koren G "The mechanism of the verapamil-digoxin interaction in renal tubular cells (LLC-PK1)." Life Sci 53 (1993): PL399-403
Marcus FI "Pharmacokinetic interactions between digoxin and other drugs." J Am Coll Cardiol 5 (1985): a82-90
McTavish D, Sorkin EM "Verapamil: an updated review of its pharmacodynamic and pharmacokinetic properties, and therapeutic use in hypertension." Drugs 38 (1989): 19-76
Belz GG, Doering W, Munkes R, Matthews J "Interaction between digoxin and calcium antagonists and antiarrhythmic drugs." Clin Pharmacol Ther 33 (1983): 410-7
Hedman A, Angelin B, Arvidsson A, et al "Digoxin-verapamil interaction: reduction of biliary but not renal digoxin clearance in humans." Clin Pharmacol Ther 49 (1991): 256-62
Pedersen KE, Christiansen BD, Kjaer K, Klitgaard NA, Nielsen-Kudsk F "Verapamil-induced changes in digoxin kinetics and intraerythrocytic sodium concentration." Clin Pharmacol Ther 34 (1983): 8-13
Baky SH, Singh BN "Verapamil hydrochloride: pharmacological properties and role in cardiovascular therapeutics." Pharmacotherapy 2 (1982): 328-50
Drescher S, Glaeser H, Murdter T, Hitzl M, Eichelbaum M, Fromm MF "P-glycoprotein-mediated intestinal and biliary digoxin transport in humans." Clin Pharmacol Ther 73 (2003): 223-31
Bauer LA, Horn JR, Pettit H "Mixed-effect modeling for detection and evaluation of drug interactions: digoxin-quinidine and digoxin-verapamil combinations." Ther Drug Monit 18 (1996): 46-52
Merin RG, Moller IW "Cardiac arrest following intravenous verapamil may be related to concomitant digoxin therapy as well as halothane." Br J Anaesth 61 (1988): 366
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Pedersen KE, Dorph-Pedersen A, Hvidt S, Klitgaard NA, Nielsen-Kudsk F "Digoxin-verapamil interaction." Clin Pharmacol Ther 30 (1981): 311-6
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Zatuchni J "Verapamil-digoxin interaction." Am Heart J 108 (1984): 412-3
Kuhlmann J, Marcin S "Effects of verapamil on pharmacokinetics and pharmacodynamics of digitoxin in patients." Am Heart J 110 (1985): 1245-50
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"Product Information. Covera-HS (verapamil)." Searle, Skokie, IL.

Digoxin Intravenous

Generic Name: digoxin

Brand name: Digitek, Digox, Lanoxin, Lanoxicaps, Cardoxin

Synonyms: Digoxin

What is Digoxin Intravenous?

Isoptin SR

Generic Name: verapamil

Brand name: Calan SR, Isoptin SR, Calan, Verelan, Isoptin, Isoptin IV, Covera-HS, Verelan PM

Synonyms: n.a.

What is Isoptin SR?

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In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.

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