Digitoxin Amiodarone

DIGITOXIN AMIODARONE Reports of digitoxin toxicity in two patients on digitoxin after starting amiodarone Uncertain thought to be due to inhibition of P-gp-mediated renal clearance of digoxin Watch for digitoxin toxicity... 

Acetaminophen, aldrin, alfentanil, amiodarone, aminopyrine, amitriptyline, amprenavir, androstenedione,antipyrine, astemizole, benzphetamine, budesonide, carbamazepine, celecoxib, chlorpromazine, chlorzoxazone, cisapride, clarithromycin, clozapine, cocaine, codeine, cortisol, cyclophosphamide,cyclosporin, dapsone, delavirdine, dextromethorphan, digitoxin, diltiazem, diazepam, erythromycin, 17j3-estradiol, ethinylestradiol, etoposide, felbamate, fentanyl, flutamide, hydroxyarginine, ifosphamide, imipramine, indinavir, ketoconazole, lansoprazole, loratidine, losartan, lovastatin, (iS)"mephen3d in, methadone, mianserin, miconazole, mifepristone, nelfinavir, nevirapine, nicardipine, nifedipine, odansetron, omeprazole, orphenadrine, proguanil, propafenone, quinidine, quinine, rapamycin, retinoic acid, ritonavir, saquinavir, selegiline, serindole, sufentanil, sulfinpyrazone, tacrolimus, tamoxifen, tamsulosin, taxol, teniposide, terfenadine, tetrahydrocannabinol, theophylline, toremifene, triazolam, trimethadone, trimethoprim, troleandomycin, verapamil, warfarin, zatosetron, Zolpidem, zonisamide... 

Digoxm levels can be approximately doubled by amiodarone. Some individuals may show even greater increases. The same interaction also appears to occur with digitoxin. 

It is thought that amiodarone can also inhibit the metabolism of digitoxin by the liver, which would explain why its serum levels are increased. ... 

Far less is known about the interaction between digitoxin and amiodarone but the limited evidence available suggests that all of the precautions appropriate for digoxin should be used for digitoxin as well. Note that the interaction may possibly take months to develop. 

LSer S, Scholz H, Buschmann I, Thoenes M, Meineitz T. Digitoxin intoxication durii concomitant use of amiodarone. EurJCUn Pharmacol (1998) 54,95-6. 

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