The digoxin-amiodarone interaction

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Abstract
To assess the cause of the digoxin-amiodarone interaction, the systemic availability and renal excretion of digoxin were examined in 10 patients. Patients were studied before and after 1 week and 6 weeks of concurrent amiodarone therapy, and four were also studied after 4–8 months. Mean (±SD) peak plasma digoxin concentration rose from 1.55±0.6 μg/l prior to amiodarone therapy to 2.85±1.3 μg/l after 1 week of combined therapy (p<0.01). Mean AUC also rose from 7.2±2.1 μg/l.h to 12.1±6.4 μg/l.h (p<0.01) during this period. Mean peak plasma digoxin concentration and AUC remained elevated after 6 weeks and, in the patients studied, at 4–8 months. Mean urinary digoxin clearance remained unchanged. Plasma amiodarone and desethylamiodarone concentrations were consistent with the prescribed doses. This study confirmed previous findings of raised plasma digoxin concentrations following the addition of amiodarone. It has also shown that this interaction is sustained for at least several months. The cause has not been fully elucidated but does not appear to be due to a change in the renal clearance of digoxin.