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Digoxin is also known as cardiotonin in clinical practice. It can be used for acute and chronic heart failure caused by hypertension, valvular heart disease, congenital heart disease, etc., especially for atrial fibrillation with rapid ventricular rate; Pulmonary heart disease, severe myocardial ischemia, active myocarditis and severe anemia, hypothyroidism and other symptoms are less effective.

In addition, it is also used in the clinical control of rapid atrial fibrillation, ventricular rate and supraventricular tachycardia in patients with atrial flutter, and also has a certain effect on fetal heart rate with or without water.

Because the drug has the characteristics of rapid excretion and small accumulation, it is safer than digoxigenin, so it is widely used in clinical practice, but excessive or inappropriate compatibility may cause certain toxic reactions, so it should be used in clinical application. Pay special attention.

1. Itraconazole

Digoxin is mainly excreted from the kidney in its original form, and its mechanism includes glomerular filtration and active secretion through the renal tubular cell P-glycoprotein drug spill pump, while itraconazole inhibits P-glycoprotein-mediated elevation Xin active secretion, so that the digoxin kidney clearance rate is reduced, resulting in increased blood drug concentration, life-threatening arrhythmia can occur, so the two drugs need to avoid the combination, but the clinical need to be combined, it is recommended to reduce the use of digoxin dose.

2. Isochloroammonium chloride

When digoxin is combined with phenolic ammonium chloride, it causes atrioventricular block, bradycardia, and cardiac arrest, so patients treated with digoxin need to ban iodochloroammonium.

3. Propiamine

When digoxin and propiamine are combined to treat rapid atrial fibrillation, digoxin can be prevented from protecting the ventricular rate, and there is a potential danger of increasing the ventricular rate. Therefore, the two drugs need to be avoided.

4. Amiodarone

When amiodarone is combined with digoxin, studies have suggested that amiodarone can cause hypothyroidism, while hypothyroidism can lead to elevated levels of digoxin blood to achieve poisoning levels. Some studies have suggested changes in thyroid function. There is no quantitative correlation with the changes in the pharmacokinetics of digoxin.

From this point of view, amiodarone can reduce the renal clearance and non-renal clearance of digoxin. Therefore, the blood concentration of digoxin should be closely monitored during the combination of the two drugs, and the symptoms of digoxin poisoning should be observed. Signs appear, and if necessary, the dosage of digoxin should be adjusted in time.

5. Phenoresin

When trihexyphenidin is combined with digoxin, trihexyphenidone can prolong the residence time of digoxin in the gastrointestinal tract and increase the absorption, which is easy to cause poisoning. Therefore, the two drugs should be avoided.

6. Calcium acetate

Calcium acetate combined with digoxin has a synergistic effect on the heart, which is easy to induce toxic reactions such as cardiac arrest. Therefore, calcium acetate should be avoided during the administration of digoxin.

7. Triamcinolone

When triamcinolone acetonide is combined with digoxin, it can increase the toxicity of digitalis and heart rhythm disorders. Therefore, the two drugs should be avoided. It is recommended to reduce the dosage when used in combination and use them at intervals.

8. Benzodiazepines

When benzodiazepines such as diazepam, oxazepam, and triazolam are combined with digoxin, the serum concentration of digoxin can be increased, its pharmacological effects can be enhanced, and gastrointestinal symptoms and neuropsychosis may occur. Symptoms such as symptoms and arrhythmia. Therefore, the two drugs need to avoid the combination, but when clinical need to be combined, it is recommended to refer to the serum concentration of digoxin, appropriate to reduce the dose of digoxin, so as not to cause poisoning reaction.

9. Macrolides

When macrolides such as erythromycin, roxithromycin, and clarithromycin are combined with digoxin, macrolides can change the gastrointestinal flora and improve the bioavailability of digoxin. Because macrolides can inhibit the P-glycoprotein transport system, inhibit the renal excretion of digoxin and increase its toxicity, it is recommended to strengthen clinical and digoxin serum concentration monitoring during the combination of the two drugs, and combined The dose of digoxin should be reduced during the period of macrolides and at least 1 month after the discontinuation of macrolides.

10. Diltiazem

When diltiazem is combined with digoxin, diltiazem can reduce the clearance rate of digoxin, enhance the pharmacological action of digoxin, increase the blood concentration of digoxin, increase the risk of digitalis poisoning, and cause severe heartbeat. It is too slow, so during the combination of the two drugs, it is recommended to closely monitor the clinical and appropriately reduce the dose of digoxin.

11. Dexamethasone

When dexamethasone is combined with digoxin, it can cause hypokalemia, which leads to the side effects of digitalis and heart rhythm disorders. Therefore, when the two drugs need to be combined, it is necessary to adjust the two drugs according to the blood drug concentration monitoring results. Use the dose.

12. Non-steroidal anti-inflammatory drugs

When digoxin is combined with non-steroidal anti-inflammatory drugs, the serum concentration may increase temporarily, and the treatment and toxicity will be temporarily enhanced. Therefore, when interaction occurs during the treatment, it is recommended to reduce digoxin. The dose is used, but the use of the dose is only temporary. It is also necessary to strengthen the monitoring of blood concentration and closely observe the clinical symptoms and timely symptomatic treatment.

13. Calcium

Patients who are taking digoxin will increase their heart if they are given intravenous calcium quickly.

Toxic effects, resulting in severe arrhythmias. Therefore, if a patient who is being treated with digoxin does need to use a calcium preparation, an oral calcium preparation is recommended.

14. Thiazide diuretics

Thiazide diuretics can induce hypokalemia and hypomagnesemia, making digoxin sodium –

Potassium-ATPase inhibition is enhanced, so that digitalis poisoning reaction occurs when combined. Therefore, it is recommended to closely monitor the electrolyte level of the patients during the combination of the two drugs, and do a good job of potassium supplementation. Even if the patient’s blood potassium is normal, the patient should be enriched. Potassium-rich foods with extra potassium in the diet.

15. Mannitol

When mannitol is combined with digoxin, it can cause hypokalemia, which will increase the toxicity of digoxin. Therefore, the two drugs need to be used with caution.

16. Lisheping

Respine has anti-sympathetic nerve, relatively enhanced vagal excitability, slowing heart rate and conduction. When combined with digoxin, it can cause severe bradycardia and conduction block, and sometimes can induce ectopic rhythm, so two Drugs need to be used with caution. When the ventricular rate of rapid atrial fibrillation is controlled by digoxin alone, it is recommended to add appropriate amount of risperidin, and closely monitor ECG, and adjust the dosage of the drug at any time.

17. Amphotericin B

Amphotericin B combined with digoxin can cause hypokalemia and increase digoxigenin

The toxicity of the drug-like drugs, therefore, the two drugs need to be used with caution. During the combination, it is recommended to strengthen clinical monitoring and blood potassium monitoring to correct potassium deficiency in time.

18. Anticholinergic drugs

Anticholinergic drugs can slow the gastrointestinal tract peristalsis, thereby increasing the bioavailability of digoxin, resulting in increased absorption of digoxin in the gastrointestinal tract, increased pharmacological effects, and increased toxicity, so during drug combination It is necessary to closely monitor the symptoms of digoxin poisoning and adjust the dose of digoxin in time.

19. Loop diuretics

When diuretic drugs are combined with digoxin, loop diuretics can increase the excretion of magnesium and potassium. Potassium deficiency and magnesium deficiency can increase the sensitivity of myocardial to digoxin toxicity, resulting in an increased frequency of arrhythmia attacks. During the period of use, it is recommended to closely monitor the serum potassium index and the concentration of digoxin blood, if necessary, timely potassium supplementation or adjustment of the dose of the two drugs.

20. Cyclosporine

It has been reported that patients taking digoxin within a few days after taking cyclosporine

The severe digitalis poisoning reaction occurs because the cyclosporine can reduce the apparent volume of digoxin by 71% and the plasma clearance by 53%, resulting in enhanced toxicity. Therefore, cyclosporine and digoxin should be used with caution. If clinical use is required, it is recommended to strengthen clinical monitoring and monitoring of digoxin blood concentration, and adjust the dose of digoxin as appropriate.

21. Quinidine

When quinidine is combined with digoxin, the blood concentration of digoxin can be increased by about one time, and the degree of improvement is related to the dose of quinidine used, and even reaches the poisoning concentration. Since quinidine can displace digoxin from tissue binding and reduce its volume of distribution, even if digoxin is stopped, its blood concentration will continue to rise. In the clinical need of the combination of two drugs for treatment, it is recommended to reduce the amount of digoxin 1/2-1/3.

22. Quinine

When quinine is combined with digoxin, quinine can increase the blood concentration of digoxin, reduce the clearance rate, and prolong its half-life, thereby enhancing the toxicity. Therefore, the two drugs need to be used with caution. If you need to use them together, you should closely strengthen the clinical observation or blood concentration monitoring, pay attention to the drug dosage at the beginning or after the adjustment.

23. Clozapine

When clozapine is combined with digoxin, it increases toxicity and aggravates myelosuppressive effects, so the two drugs need to be avoided.

24. Spironolactone

Studies have shown that when spironolactone is combined with digoxin, spironolactone can lower the renal clearance rate of digoxin, and the blood concentration can be increased by 30%, thereby prolonging the half-life of digoxin and increasing the risk of toxicity. Digoxin drug monitoring should be done during the period of use.

25. Buspirone

Buspirone can free digoxin from the plasma protein binding state,

When combined, it can increase the blood concentration of digoxin and increase the incidence of toxic reaction. Therefore, the concentration of digoxin blood should be closely monitored during the combination of the two drugs. Unless it is necessary to use it, it is not recommended to use both drugs at the same time.

26. Sulphonium bromide

The effect of digoxin on the heart can be more pronounced due to the action of sulphorium bromide.

Increase the risk of cardiotoxicity, sudden arrhythmia in severe cases, so the two drugs should be avoided.

27. Hydroxychloroquine

When hydroxychloroquine is combined with digoxin, it can reduce the renal clearance rate of digoxin.

Digoxin, which binds to plasma proteins, is exchanged to alter the distribution of digoxin in the body. In some cases, patients taking hydroxychloroquine in combination with digoxin, digoxin blood concentration increased, although no fatal danger, but the blood concentration of digoxin rose to the poisoning range, so the two drugs need to be used with caution During the combined use, it is necessary to closely monitor the blood concentration of digoxin and make emergency measures at any time.

28. Azosemi

Azosemi combined with digoxin will cause digitalis poisoning, so the two drugs should be avoided.

 

The digoxin poisoning that has been mentioned mainly includes four aspects: cardiac, gastrointestinal, central nervous system, and visual change.

(1) Heart: Cardiac toxicity mainly accounts for 70-95%, manifested as ventricular premature beats, atrioventricular nodules, atrioventricular septum, 2, 3 degrees to block, paroxysmal atrial velocity with atrioventricular block Stagnation, atrial fibrillation, ventricular tachycardia, etc.

(2) Gastrointestinal aspects: The gastrointestinal tract is mainly characterized by anorexia, nausea, vomiting, diarrhea, and abdominal pain.

(3) Central nervous system: The central nervous system accounts for 13-25% of the performance of digoxin poisoning, mainly manifested as fatigue, insomnia, confusion, and mental disorders.

(4) Visual change: visual change mainly manifests as green and yellow. Considering the poisoning reaction that can be caused by the combination of digoxin and other drugs, for patients who need to be combined, the monitoring of digoxin blood concentration should be strengthened when using with drugs, and the use of digoxin and combination drugs should be adjusted. Dosage, develop a reasonable dosing regimen to ensure medication safety.

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