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Drug Interactions between digitoxin and esmolol

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

digitoxin esmolol

Applies to: digitoxin and esmolol

MONITOR: Concomitant use of digitalis glycosides and beta-blockers may increase the risk of bradycardia. These agents slow atrioventricular conduction and decrease heart rate, hence they may have additive cardiac effects during coadministration. Some beta-blockers such as carvedilol, esmolol, and talinolol have also been reported to increase the systemic bioavailability of digoxin. The mechanism may involve enhanced absorption as well as reduced renal excretion of digoxin due to inhibition of intestinal and renal P-glycoprotein efflux transporter.

MANAGEMENT: Caution is advised during coadministration of digitalis glycosides and beta-blockers. Serum digitalis levels, heart rate, and blood pressure should be monitored closely, particularly during the first few weeks of concomitant therapy. Patients should be advised to notify their physician if they experience anorexia, nausea, visual changes, irregular heartbeat, slow pulse, dizziness, or syncope. Beta-blockers should not be used in patients with overt or decompensated congestive heart failure, as sympathetic stimulation may be a vital component in maintaining hemodynamic function in these patients and its inhibition by beta blockade may worsen the heart failure.

References (12)
  1. LeWinter MM, Crawford MH, O'Rourke RA, Karliner JS (1977) "The effects of oral propranolol, digoxin and combination therapy on the resting and exercise electrocardiogram." Am Heart J, 93, p. 202-9
  2. Watt DA (1968) "Sensitivity to propranolol after digoxin intoxication." Br Med J, 2, p. 413-4
  3. De Mey C, Brendel E, Enterling D (1990) "Carvedilol increases the systemic bioavailability of oral digoxin." Br J Clin Pharmacol, 29, p. 486-90
  4. Lowenthal DT, Porter RS, Saris SD, Bies CM, Slegowski MB, Staudacher A (1985) "Clinical pharmacology, pharmacodynamics and interactions with esmolol." Am J Cardiol, 56, f14-8
  5. (2001) "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories
  6. Lowenthal DT, Porter RS, Achari R, Turlapaty P, Laddu AR, Matier WL (1987) "Esmolol-digoxin drug interaction" J Clin Pharmacol, 27, p. 561-6
  7. (2001) "Product Information. Zebeta (bisoprolol)." Lederle Laboratories
  8. Wermeling DP, Field CJ, Smith DA, Chandler MH, Clifton GD, Boyle DA (1994) "Effects of long-term oral carvedilol on the steady-state pharmacokinetics of oral digoxin in patients with mild to moderate hypertension." Pharmacotherapy, 14, p. 600-6
  9. (2001) "Product Information. Coreg (carvedilol)." SmithKline Beecham
  10. Eichhorn EJ, Lukas MA, Wu B, Shusterman N (2000) "Effect of concomitant digoxin and carvedilol therapy of mortality and morbidity in patients with chronic heart failure." Am J Cardiol, 86, p. 1032-5
  11. Ratnapalan S, Griffiths K, Costei AM, Benson L, Koren G (2003) "Digoxin-carvedilol interactions in children." J Pediatr, 142, p. 572-574
  12. Takara K, Kakumoto M, Tanigawara Y, Funakoshi J, Sakaeda T, Okumura K (2002) "Interaction of digoxin with antihypertensive drugs via MDR 1." Life Sci, 70, p. 1491-1500

Drug and food interactions

Moderate

esmolol food

Applies to: esmolol

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia. Patients should also avoid driving or operating hazardous machinery until they know how the medications affect them.

References (10)
  1. Sternbach H (1991) "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol, 11, p. 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA (1984) "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med, 101, p. 498-9
  3. Feder R (1991) "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry, 52, p. 139
  4. Ellison JM, Milofsky JE, Ely E (1990) "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry, 51, p. 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. (2001) "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit, 23, p. 435-40
  6. Cerner Multum, Inc. "Australian Product Information."
  7. Pacher P, Kecskemeti V (2004) "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des, 10, p. 2463-75
  8. Andrews C, Pinner G (1998) "Postural hypotension induced by paroxetine." BMJ, 316, p. 595
  9. (2023) "Product Information. Buprenorphine (buprenorphine)." G.L. Pharma UK Ltd
  10. (2023) "Product Information. Temgesic (buprenorphine)." Reckitt Benckiser Pty Ltd

Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
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.
Unknown No interaction information available.

Further information

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