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Lanoxin (digoxin) Disease Interactions

There are 11 disease interactions with Lanoxin (digoxin):

Digoxin (Includes Lanoxin) ↔ Accessory Av Pathway

Severe Potential Hazard, High plausibility

Applies to: Preexcitation Syndrome

Digoxin may enhance accessory pathway conduction in conditions such as the Wolff-Parkinson-White syndrome. Following intravenous digoxin therapy, some patients with paroxysmal atrial fibrillation or flutter and a coexisting accessory AV pathway have developed increased antegrade conduction across the accessory pathway bypassing the AV node, leading to a very rapid ventricular response or ventricular fibrillation. Unless conduction down the accessory pathway has been blocked, either pharmacologically or by surgery, digoxin should not be used in such patients. The treatment of paroxysmal supraventricular tachycardia in such patients is usually direct-current cardioversion.

References

  1. "Product Information. Lanoxin (digoxin)." Glaxo Wellcome, Research Triangle Park, NC.

Digoxin (Includes Lanoxin) ↔ Bradyarrhythmia/Av Block

Severe Potential Hazard, High plausibility

Applies to: Sinus Node Dysfunction, Heart Block

Digoxin slows sinoatrial and AV conduction, commonly prolonging the PR interval. When treated with digoxin, patients with preexisting sinus node disease may develop severe sinus bradycardia or sinoatrial block, and patients with incomplete AV block may progress to advanced or complete heart block. In such patients, consideration should be given to the insertion of a pacemaker prior to initiating treatment with digoxin. Digoxin may be administered to patients with complete, stable AV block who have congestive heart failure, provided the block was not induced by cardiac glycosides.

References

  1. "Product Information. Lanoxin (digoxin)." Glaxo Wellcome, Research Triangle Park, NC.
  2. Gould L, Patel C, Betzu R, Judge D, Lee J "Right bundle branch block: a rare manifestation of digitalis toxicity- -case report." Angiology 37 (1986): 543-6
  3. Banerjee AK, Campbell RWF "Digoxin therapy and survival in heart failure in sinus rhythm." Int J Cardiol 55 (1996): 9-13

Digoxin (Includes Lanoxin) ↔ Hypercalcemia

Severe Potential Hazard, High plausibility

Applies to: Hypercalcemia

Calcium and digoxin have additive inotropic effects. Therefore, hypercalcemia from any cause will predispose patients to digoxin toxicity and serious arrhythmias. Hypercalcemia should be corrected prior to initiating treatment with digoxin, and serum calcium levels should be monitored during therapy.

References

  1. "Product Information. Lanoxin (digoxin)." Glaxo Wellcome, Research Triangle Park, NC.

Digoxin (Includes Lanoxin) ↔ Hypocalcemia

Severe Potential Hazard, High plausibility

Applies to: Hypocalcemia

Hypocalcemia can nullify the effects of digoxin. The drug may be ineffective in hypocalcemic patients until serum calcium levels are restored to normal.

References

  1. "Product Information. Lanoxin (digoxin)." Glaxo Wellcome, Research Triangle Park, NC.

Digoxin (Includes Lanoxin) ↔ Hypokalemia/Hypomagnesemia

Severe Potential Hazard, High plausibility

Applies to: Malnourished, Diarrhea, Hypokalemia, Magnesium Imbalance, Vomiting, Electrolyte Abnormalities, hemodialysis, Hyperaldosteronism

Potassium and/or magnesium depletion sensitizes the myocardium to digoxin. In patients with hypokalemia or hypomagnesemia, digoxin toxicity may occur despite serum drug concentrations below 2.0 ng/ml. Therapy with digoxin should be administered cautiously in patients with or predisposed to potassium and/or magnesium deficiency, including patients on diuretic therapy; those with primary or secondary aldosteronism (may have low potassium levels); those with severe or prolonged diarrhea or vomiting; those with malnutrition; and renal dialysis patients. Electrolyte imbalances should be corrected prior to initiation of treatment. Serum potassium and magnesium concentrations should be monitored during therapy.

References

  1. Brater DC, Morrelli HF "Digoxin toxicity in patients with normokalemic potassium depletion." Clin Pharmacol Ther 22 (1977): 21-33
  2. Whang R, Oei TO, Watanabe A "Frequency of hypomagnesemia in hospitalized patients receiving digitalis." Arch Intern Med 145 (1985): 655-6
  3. "Product Information. Lanoxin (digoxin)." Glaxo Wellcome, Research Triangle Park, NC.
View all 4 references

Digoxin (Includes Lanoxin) ↔ Preserved Left Ventricular Ejection

Severe Potential Hazard, High plausibility

Applies to: Cardiomyopathy, Cor Pulmonale, Constrictive Pericarditis

Patients with heart failure associated with preserved left ventricular systolic function, such as in restrictive cardiomyopathy, constrictive pericarditis, amyloid heart disease and acute cor pulmonale, may be particularly susceptible to the toxicity of digoxin. Therapy with digoxin should be considered and administered cautiously in such patients. In hypertrophic cardiomyopathy (idiopathic hypertrophic subaortic stenosis), the inotropic effects of digoxin may worsen the outflow obstruction.

References

  1. "Product Information. Lanoxin (digoxin)." Glaxo Wellcome, Research Triangle Park, NC.

Digoxin (Includes Lanoxin) ↔ Renal Dysfunction

Severe Potential Hazard, High plausibility

Applies to: Renal Dysfunction

Digoxin is primarily eliminated by the kidney. Patients with renal impairment may be at increased risk for digoxin toxicity, including ventricular arrhythmias and AV conduction disturbances, due to decreased drug clearance. Therapy with digoxin should be administered cautiously in patients with impaired renal function. Dosage adjustments should be made according to product package labeling and patient attributes such as age, ideal body weight and other concomitant disease states and medication usage. Dosage increments should be made very gradually, since the elimination half-life may be prolonged in these patients and a longer period of time is required to establish steady-state serum concentrations than normal. These patients should be monitored closely for manifestations of toxicity, and dosages further adjusted as necessary. If toxicity occurs, clinicians should be aware that the adverse effects may also be prolonged.

References

  1. Aronson JK "Clinical pharmacokinetics of cardiac glycosides in patients with renal dysfunction." Clin Pharmacokinet 8 (1983): 155-78
  2. Jusko WJ, Szefler SJ, Goldfarb AL "Pharmacokinetic design of digoxin dosage regimens in relation to renal function." J Clin Pharmacol 14 (1974): 525-35
  3. Ohnhaus EE, Vozeh S, Nuesch E "Absolute bioavailability of digoxin in chronic renal failure." Clin Nephrol 11 (1979): 302-6
View all 13 references

Digoxin (Includes Lanoxin) ↔ Ventricular Arrhythmia

Severe Potential Hazard, High plausibility

Applies to: Ventricular Arrhythmia

The use of digoxin is contraindicated in patients with ventricular fibrillation. Digoxin toxicity is associated with adverse cardiac effects, including ventricular arrhythmias, which are most commonly seen in chronic toxicity. Digoxin-induced ventricular tachycardia is associated with a high mortality rate, since ventricular fibrillation or asystole may result. Therapy with digoxin should be considered and administered cautiously in patients with frequent ventricular premature contractions or ventricular tachycardia, especially if these arrhythmias are not caused by heart failure.

References

  1. Warren JL, Mcbean AM, Hass SL, Babish JD "Hospitalizations with adverse events caused by digitalis therapy among elderly medicare beneficiaries." Arch Intern Med 154 (1994): 1482-7
  2. Castellanos A, Lemberg L, Centurion M "The mechanisms of digitalis-induced ventricular fibrillation." Dis Chest 54 (1968): 53-7
  3. Moorman JR, Pritchett EL "The arrhythmias of digitalis intoxication." Arch Intern Med 145 (1985): 1289-92
View all 9 references

Digoxin (Includes Lanoxin) ↔ Acute Mi

Moderate Potential Hazard, High plausibility

Applies to: Myocardial Infarction

The use of inotropic drugs in some patients with acute myocardial infarction may lead to increases in myocardial oxygen demand and ischemia. Therapy with digoxin should be administered cautiously in this setting.

References

  1. "Product Information. Lanoxin (digoxin)." Glaxo Wellcome, Research Triangle Park, NC.
  2. Kober L, Torppedersen C, Gadsboll N, Hildebrandt P, Hoilundcarlsen PF "Is digoxin an independent risk factor for long-term mortality after acute myocardial infarction." Eur Heart J 15 (1994): 382-8
  3. Leor J, Goldbourt U, Behar S "Is it safe to prescribe digoxin after acute myocardial infarction? update on continued controversy." Am Heart J 130 (1995): 1322-6

Digoxin (Includes Lanoxin) ↔ Hyperthyroidism

Moderate Potential Hazard, High plausibility

Applies to: Hyperthyroidism

Heart failure and/or atrial arrhythmias resulting from hypermetabolic or hyperdynamic states such as hyperthyroidism, hypoxia, or arteriovenous shunt are best managed by treating the underlying condition. Atrial arrhythmias associated with hypermetabolic states are particularly refractory to digoxin, possibly due to altered pharmacokinetics. Specifically, the apparent volume of distribution and renal elimination of the drug may be increased, resulting in lower serum concentrations. Therapy with digoxin should be administered cautiously in patients with hyperthyroidism. Serum digoxin levels should be monitored regularly and dosage adjustments may be required secondary to changes in their thyroid condition.

References

  1. Lawrence JR, Sumner DJ, Kalk WJ, et al "Digoxin kinetics in patients with thyroid dysfunction." Clin Pharmacol Ther 22 (1977): 7-13
  2. "Product Information. Lanoxin (digoxin)." Glaxo Wellcome, Research Triangle Park, NC.
  3. O'Connor P, Feely J "Clinical pharmacokinetics and endocrine disorders. Therapeutic implications." Clin Pharmacokinet 13 (1987): 345-64
View all 5 references

Digoxin (Includes Lanoxin) ↔ Hypothyroidism

Moderate Potential Hazard, High plausibility

Applies to: Hypothyroidism

Hypothyroidism may reduce the requirements for digoxin due to decreased volume of distribution and plasma clearance of the drug. Therapy with digoxin should be initiated at lower dosages in patients with hypothyroidism to avoid toxicity. Serum digoxin levels should be monitored regularly and dosage adjustments may be required secondary to changes in their thyroid condition.

References

  1. O'Connor P, Feely J "Clinical pharmacokinetics and endocrine disorders. Therapeutic implications." Clin Pharmacokinet 13 (1987): 345-64
  2. "Product Information. Lanoxin (digoxin)." Glaxo Wellcome, Research Triangle Park, NC.
  3. Lawrence JR, Sumner DJ, Kalk WJ, et al "Digoxin kinetics in patients with thyroid dysfunction." Clin Pharmacol Ther 22 (1977): 7-13
View all 4 references

You should also know about...

Lanoxin (digoxin) drug Interactions

There are 792 drug interactions with Lanoxin (digoxin)

Lanoxin (digoxin) alcohol/food Interactions

There is 1 alcohol/food interaction with Lanoxin (digoxin)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.

Do not stop taking any medications without consulting your healthcare provider.

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