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Interaction between digoxin and propafenone.

M V Calvo1, A Martin-Suarez, C Martin Luengo

  • 1Department of Pharmacy, Faculty of Pharmacy, University of Salamanca, Spain.

Therapeutic Drug Monitoring
|January 1, 1989
PubMed
Summary
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Propafenone significantly increases digoxin levels in patients with heart disease, potentially leading to toxicity. Close monitoring of serum digoxin concentration and dose adjustments are crucial when these drugs are used together.

Area of Science:

  • Cardiology
  • Clinical Pharmacology
  • Pharmacokinetics

Background:

  • Digoxin is a cardiac glycoside used for heart failure and arrhythmias.
  • Propafenone is a Class Ic antiarrhythmic drug.
  • Interactions between digoxin and propafenone require investigation.

Purpose of the Study:

  • To investigate the pharmacokinetic and pharmacodynamic interactions between digoxin and propafenone.
  • To assess the impact of propafenone on digoxin serum concentrations and clearance.
  • To evaluate the effects on heart rate and QTc interval.

Main Methods:

  • 10 hospitalized patients with heart disease and arrhythmias were studied.
  • Patients received a stable dose of digoxin (0.25 mg/day).
  • Digoxin was co-administered with propafenone (600 mg/day) for 1 week.

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Main Results:

  • Propafenone significantly increased mean serum digoxin concentration (SDC) from 0.97 to 1.54 ng/ml (p < 0.003).
  • Propafenone decreased total and renal digoxin clearances by approximately 31%.
  • Increased SDCs correlated with decreased heart rate and QTc interval shortening.

Conclusions:

  • Propafenone significantly elevates serum digoxin concentrations.
  • This interaction necessitates careful monitoring of SDCs in patients receiving both drugs.
  • Dosage reduction of digoxin may be required to prevent toxicity.