Skip to main content

Drug Interactions between digoxin and Metoprolol Succinate ER

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

Edit list (add/remove drugs)

Interactions between your drugs

Moderate

metoprolol digoxin

Applies to: Metoprolol Succinate ER (metoprolol) and digoxin

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

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

Switch to consumer interaction data

Drug and food interactions

Moderate

metoprolol food

Applies to: Metoprolol Succinate ER (metoprolol)

ADJUST DOSING INTERVAL: The bioavailability of metoprolol may be enhanced by food.

MANAGEMENT: Patients may be instructed to take metoprolol at the same time each day, preferably with or immediately following meals.

References

  1. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals PROD (2001):
  2. Darcy PF "Nutrient-drug interactions." Adverse Drug React Toxicol Rev 14 (1995): 233-54

Switch to consumer interaction data

Moderate

metoprolol food

Applies to: Metoprolol Succinate ER (metoprolol)

ADJUST DOSING INTERVAL: Concurrent administration with calcium salts may decrease the oral bioavailability of atenolol and possibly other beta-blockers. The exact mechanism of interaction is unknown. In six healthy subjects, calcium 500 mg (as lactate, carbonate, and gluconate) reduced the mean peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of atenolol (100 mg) by 51% and 32%, respectively. The elimination half-life increased by 44%. Twelve hours after the combination, beta-blocking activity (as indicated by inhibition of exercise tachycardia) was reduced compared to that with atenolol alone. However, during a 4-week treatment in six hypertensive patients, there was no difference in blood pressure values between treatments. The investigators suggest that prolongation of the elimination half-life induced by calcium coadministration may have led to atenolol cumulation during long-term dosing, which compensated for the reduced bioavailability.

MANAGEMENT: It may help to separate the administration times of beta-blockers and calcium products by at least 2 hours. Patients should be monitored for potentially diminished beta-blocking effects following the addition of calcium therapy.

References

  1. Kirch W, Schafer-Korting M, Axthelm T, Kohler H, Mutschler E "Interaction of atenolol with furosemide and calcium and aluminum salts." Clin Pharmacol Ther 30 (1981): 429-35

Switch to consumer interaction data

Minor

digoxin food

Applies to: digoxin

Administration of digoxin with a high-fiber meal has been shown to decrease its bioavailability by almost 20%. Fiber can sequester up to 45% of the drug when given orally. Patients should be advised to maintain a regular diet without significant fluctuation in fiber intake while digoxin is being titrated.

Grapefruit juice may modestly increase the plasma concentrations of digoxin. The mechanism is increased absorption of digoxin due to mild inhibition of intestinal P-glycoprotein by certain compounds present in grapefruits. In 12 healthy volunteers, administration of grapefruit juice with and 30 minutes before, as well as 3.5, 7.5, and 11.5 hours after a single digoxin dose (0.5 mg) increased the mean area under the plasma concentration-time curve (AUC) of digoxin by just 9% compared to administration with water. Moreover, P-glycoprotein genetic polymorphism does not appear to influence the magnitude of the effects of grapefruit juice on digoxin. Thus, the interaction is unlikely to be of clinical significance.

References

  1. Darcy PF "Nutrient-drug interactions." Adverse Drug React Toxicol Rev 14 (1995): 233-54
  2. Becquemont L, Verstuyft C, Kerb R, et al. "Effect of grapefruit juice on digoxin pharmacokinetics in humans." Clin Pharmacol Ther 70 (2001): 311-6

Switch to consumer interaction data

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.

See also

Report options

Loading...
QR code containing a link to this page

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

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer