Amiodarone increases digoxin blood levels by approximately 70 to 100 percent, which can cause digoxin toxicity. Symptoms of digoxin toxicity include nausea, vomiting, visual disturbances (yellow-green halos), confusion, and life-threatening cardiac arrhythmias.
How This Interaction Works (Mechanism)
Amiodarone inhibits P-glycoprotein (P-gp), the transporter responsible for digoxin excretion in the kidneys and GI tract. It also reduces renal clearance of digoxin through effects on renal tubular secretion. These combined effects can double digoxin plasma concentrations within one to two weeks of starting amiodarone. Since digoxin has a narrow therapeutic index (therapeutic range 0.5 to 2.0 ng/mL), even modest increases in blood levels can cause toxicity.
Source: Heart Rhythm Society Clinical Practice Guidelines, 2024
When amiodarone is added to digoxin therapy, the digoxin dose should be reduced by 50 percent immediately. Monitor digoxin levels closely (within one week of starting amiodarone and regularly thereafter). Watch for signs of toxicity: nausea, loss of appetite, visual changes, confusion, or new cardiac arrhythmias. Target digoxin levels of 0.5 to 0.9 ng/mL when used with amiodarone.
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Digoxin and Amiodarone have a severe interaction and should generally not be taken together without close medical supervision. The combination can cause serious, potentially life-threatening side effects. Contact your doctor immediately if you are currently taking both medications.
Amiodarone increases digoxin blood levels by approximately 70 to 100 percent, which can cause digoxin toxicity. Symptoms of digoxin toxicity include nausea, vomiting, visual disturbances (yellow-green halos), confusion, and life-threatening cardiac arrhythmias.
Yes. Anytime you are taking multiple medications, supplements, or substances, you should inform your doctor and pharmacist. They can evaluate your specific risk factors (age, kidney function, other medications, medical conditions) and determine whether the Digoxin and Amiodarone combination is safe for you, or whether adjustments are needed.
Related Resources
- Supplement interactions with Digoxin on Health Britannica
- Supplement interactions with Amiodarone on Health Britannica
- Digoxin prices and pharmacy comparison on RxGrab
- Amiodarone prices and pharmacy comparison on RxGrab
- Full drug interaction checker tool
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