John s wort monoamine oxidase inhibitors maois , such as isocarboxazid marplan , phenelzine nardil , or selegiline eldepryl, emsam, zelapar certain pain medications, such as tramadol ryzolt, ultram, conzip other ssris, such as citalopram celexa blood thinners, such as warfarin coumadin aspirin and other non-steroidal anti-inflammatory drugs nsaids such as ibuprofen advil, motrin and naproxen aleve, naprosyn heartburn drugs, such as cimetidine tagamet drugs used to treat mental illness, such as lithium eskalith, lithobid, lithotabs anti-seizure medications, like carbamazepine tegretol some heart drugs, including digoxin digox, lanoxin migraine medications, such as almotriptan axert , eletriptan relpax , and frovatriptan frova other antidepressants, such as desipramine norpramin sedatives and sleeping pills, including triazolam halcion the hiv drug ritonavir norvir certain antifungal medications, such as ketoconazole nizoral, xolegel, extina the antibiotic linezolid zyvox .
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Below is a text only representation of the Patient Information LeafletThe original can be viewed in PDF format using the link above.
Heart failure and/or atrial arrhythmias resulting from hypermetabolic or hyperdynamic statese.ghyperthyroidismhypoxiaor arteriovenous shuntare best treated by addressing the underlying conditionAtrial arrhythmias associated with hypermetabolic states are particularly resistant to digoxin treatmentPatients with beri beri heart disease may fail to respond adequately to digoxin if the underlying thiamine deficiency is not treated concomitantly.
It may be desirable to reduce the dose of or discontinue digoxin for 1 to 2 days prior to electrical cardioversion of atrial fibrillation to avoid the induction of ventricular arrhythmiasbut physicians must consider the consequences of increasing the ventricular response if digoxin is decreased or withdrawnIf digitalis toxicity is suspectedelective cardioversion should be delayedIf it is not prudent to delay cardioversionthe lowest possible energy level should be selected to avoid provoking ventricular arrhythmias.
Digoxin increases the strength and efficiency of heart contractionsand is useful in the treatment of heart failure and control the rate and rhythm of the heartIt is extracted from the leaves of a plant called digitalis lanataDigoxin increases the force of contraction of the muscle of the heart by inhibiting the activity of an enzymeATPasethat controls movement of calciumsodiumand potassium into heart muscleCalcium controls the force of contractionInhibiting ATPase increases calcium in heart muscle and therefore increases the force of heart contractionsDigoxin also slows electrical conduction between the atria and the ventricles of the heart and is useful in treating abnormally rapid atrial rhythms such as atrial fibrillationatrial flutterand atrial tachycardiaAbnormally rapid atrial rhythms can be caused by heart attacksexcessive thyroid hormonesalcoholisminfectionsand many other conditionsDuring rapid atrial rhythmselectrical signals from the atria cause rapid contractions of the ventriclesRapid ventricular contractions are inefficient in pumping blood containing oxygen and nutrients to the bodycausing symptoms of weaknessshortness of breathdizzinessand even chest painDigoxin alleviates these symptoms by blocking the electrical conduction between the atria and ventriclesthus slowing ventricular contractionsThe FDA approved digoxin in 1975.
Signs and symptoms of digoxin toxicity include anorexianauseavomitingvisual changes and cardiac arrhythmiasfirst-degreesecond-degreeWenckebachor third-degree heart blockincluding asystoleatrial tachycardia with blockAV dissociationaccelerated junctionalnodalrhythmunifocal or multiform ventricular premature contractionsespecially bigeminy or trigeminyventricular tachycardiaand ventricular fibrillationToxicity is usually associated with digoxin levels2ng/ml although symptoms may also occur at lower levelsLow body weightadvanced age or impaired renal functionhypokalemiahypercalcemiaor hypomagnesemia may predispose to digoxin toxicityObtain serum digoxin levels in patients with signs or symptoms of digoxin therapy and interrupt or adjust dose if necessarysee ADVERSE REACTIONS and OVERDOSAGEAssess serum electrolytes and renal function periodically.
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