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Amiodarone-digoxin interaction. Clinical and experimental observations.

W J Oetgen, S M Sobol, T B Tri

    Chest
    |July 1, 1984
    PubMed
    Summary
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    Amiodarone significantly increases serum digoxin levels in patients with cardiac arrhythmias. Pigs serve as a suitable animal model to study this amiodarone-digoxin interaction.

    Area of Science:

    • Pharmacology
    • Cardiology

    Background:

    • Cardiac arrhythmias are common and often require pharmacologic management.
    • Digoxin is a widely used medication for heart failure and arrhythmias.
    • Amiodarone is an effective antiarrhythmic agent but has numerous drug interactions.

    Purpose of the Study:

    • To investigate the effect of amiodarone on serum digoxin levels in patients.
    • To establish an animal model for studying the digoxin-amiodarone interaction.

    Main Methods:

    • Human study: 22 patients with refractory cardiac arrhythmias received amiodarone; serum digoxin levels were measured pre- and post-treatment.
    • Animal study: 18 pigs were administered digoxin; half also received amiodarone for the final two weeks.
    • Serum digoxin levels were analyzed in both patient and animal groups.

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    Main Results:

    • In patients, post-amiodarone serum digoxin levels (1.9 ng/ml) were significantly higher than pre-amiodarone levels (1.0 ng/ml) (p < .001).
    • In pigs, serum digoxin levels were significantly higher in the group receiving both digoxin and amiodarone (1.2 ng/ml) compared to digoxin alone (0.6 ng/ml) (p < .01).

    Conclusions:

    • Amiodarone significantly elevates serum digoxin levels in humans.
    • The pig is an appropriate animal model for investigating the pharmacokinetic and pharmacodynamic interactions between amiodarone and digoxin.