Interaction between Chinese medicine and digoxin: Clinical and research update

Area of Science:

• Pharmacology
• Cardiology
• Integrative Medicine

Background:

• Digoxin is a crucial medication for heart failure and arrhythmia, with a narrow therapeutic index.
• Its effective plasma concentration is close to toxic levels, necessitating careful management.
• Drug interactions, particularly with Traditional Chinese Medicine (TCM), can significantly impact digoxin levels and lead to adverse drug reactions (ADRs).

Purpose of the Study:

• To overview TCM formulations that affect digoxin's pharmacology and their mechanisms.
• To provide a theoretical reference for the safe and rational co-administration of digoxin and TCM.
• To prevent ADRs associated with digoxin-TCM combinations.

Main Methods:

• A comprehensive literature search was conducted across major electronic databases (PubMed, MEDLINE, Web of Science, etc.).
• Articles published between 1960 and 2022 were reviewed, focusing on digoxin, TCM, Chinese patent medicines, and adverse reactions.
• Included studies comprised clinical reports, pharmacological experiments, and in vitro experiments.

Main Results:

• Forty-nine relevant articles were identified, revealing complex mechanisms by which TCM affects digoxin.
• TCM formulations can alter digoxin's pharmacokinetics and pharmacodynamics by influencing gastrointestinal factors, P-glycoprotein levels, and cardiac sensitivity.
• Existing study results are often controversial, highlighting the need for further in-depth research due to compositional complexity and methodological variations.

Conclusions:

• Combinations of digoxin with TCM formulations are prevalent in clinical practice.
• Understanding these interactions is essential for avoiding ADRs.
• This review serves as a reference to improve the efficacy and safety of digoxin when used concurrently with TCM.