Cardiac glycosides with loop diuretics

Other drugs that may interact with cardiac glycosides include the following Albuterol, amphotericin B, beta-blockers, calcium, disopyramide, loop diuretics, nondepolarizing muscle relaxants, potassium-sparing diuretics, succinylcholine, sympathomimetics, thiazide diuretics, thioamines, and thyroid hormones. 

Alterations in the serum potassium level are hazardous because they can result in cardiac arrhythmias. Drugs that may cause hyperkalemia despite normal renal function include potassium itself, 13 blockers, digitalis glycosides, potassiumsparing diuretics, and fluoride. Drugs associated with hypokalemia include barium, 13 agonists, caffeine, theophylline, and thiazide and loop diuretics. 

The home health nurse is caring for a client diagnosed with congestive heart failure (CHF) who has been prescribed the cardiac glycoside digoxin (Lanoxin) and the loop diuretic furosemide (Lasix). Which statement by the client indicates the medications are effective ... 

Cyclodextrin-based drug delivery systems The hydrophilic cyclodextrins have been extensively )plied to enhance the oral bioavailabilily of steroids, cardiac glycosides, nonsteroidal anti-inflammatory drugs, barbiturates, antiepileptics, benzodiazepines, antidiabetics, vasodilators, etc. Delayed and prolonged release of diltiazem and molsidormine was achieved by their complexation with CD derivatives, modified release of nifedipine can be achieved by its complexation with 2-HP-P-CD fiirosemide and piretanide (loop diuretics) release can be modified after complexation with DM-P-CD. Prednisolone dosage forms can be optimized also by complex-formation with 2-HP-P-CD. 

Established interactions. The CSM in the UK advises that, as potentially serious hypokalaemia may result from beta2 agonist therapy, particular caution is required in severe asthma, as this effect may be potentiated by theophylline and its derivatives, corticosteroids, diuretics, and by hypoxia. Hypokalaemia with concurrent use of thiazide and loop diuretics may be reduced or even abolished by the addition of spironolactone or high-dose triamterene. Plasma potassium levels should therefore be monitored in patients with severe asthma. Hypokalaemia may result in cardiac arrhythmias in patients with ischaemic heart disease and may also affect the response of patients to drugs such as the digitalis glycosides and an-tiarrhythmics. 

No interactions are expected at standard therapeutic doses. At higher doses or with long-term use, licorice may potentiate potassium depletion of high-ceiling loop diuretics and thiazide diuretics, stimulant laxatives (Mills and Bone 2005), and corticosteroids such as prednisolone (Cheng et al. 2004 De Smet 1993), and may potentiate the action of cardiac glycosides such as digoxin (Kelly 1990). 

Concomitant use of diuretic herbs with prescription loop diuretics, thiazide diuretics, osmotic diuretics, and potassium-sparing diuretics may cause excessive fluid loss. Reductions in potassium levels caused by diuretics may increase the toxicity of cardiac glycosides, such as digoxin, and their combination should be avoided (Anon 2010). 

---