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Interaction of itraconazole and digoxin
M K Sachs1, L M Blanchard, P J Green
1Division of Infectious Diseases, Jefferson Medical College, Philadelphia, Pennsylvania.
Summary
Itraconazole can increase digoxin levels, leading to toxicity. Patients taking both medications need frequent monitoring for digoxin toxicity symptoms like nausea and vomiting.
Area of Science:
- Pharmacology
- Drug Interactions
- Clinical Toxicology
Background:
- Digoxin is a cardiac glycoside used for heart failure and arrhythmias.
- Itraconazole is an antifungal medication.
- Concurrent use of certain drugs can alter digoxin pharmacokinetics.
Observation:
- A patient on long-term digoxin therapy developed toxicity symptoms after initiating itraconazole.
- Elevated serum digoxin levels were observed.
- Itraconazole significantly increased the half-life of digoxin.
Findings:
- Coadministration of itraconazole led to a significant increase in digoxin's half-life.
- A dose reduction of nearly 60% for digoxin was required.
- Nonspecific gastrointestinal symptoms indicated early digoxin toxicity.
Implications:
- Frequent monitoring of serum digoxin levels is crucial for patients on concurrent itraconazole therapy.
- Vigilant questioning for gastrointestinal symptoms is recommended to detect early digoxin toxicity.
- This interaction highlights the importance of considering drug-drug interactions in clinical practice.