Digoxin amiodarone interaction – Cardiology MCQ – Answer

When digoxin is given along with amiodarone, dose of digoxin:

Correct answer: b) Dose should be reduced by half

Important drugs which can increase the levels of digoxin are quinidine, verapamil, amiodarone and dronedarone [1]. The dose of digoxin should be halved with concomitant use of verapamil, amiodarone or dronedarone. Drugs with high levels of protein binding displace digoxin from protein binding sites and increase the effective blood levels of digoxin. Monitoring of plasma digoxin levels and frequent evaluation for signs and symptoms of digoxin toxicity are recommended while using these drugs in combination with digoxin, when that combination is deemed essential.
Another reason for caution while combining digoxin and amiodarone is that both drugs can slow the atrioventricular (AV) conduction. But as the use of digoxin is fast waning, these concerns are not very often seen in the current scenario.

Reference

1. Smith H, Battjes E, Yan S, Kaakeh Y. Chronic Digoxin Toxicity Precipitated by Dronedarone. Ann Pharmacother. 2014 Mar 31;48(7):923-927.

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