The Effect of Quinidine and Other Oral Antiarrhythmic Drugs on Serum Digoxin

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Abstract
The effects of quinidine and 3 alternate antiarrhythmic drugs on serum digoxin concentration in 63 patients were compared before and during administration of quinidine, procainamide, disopyramide or mexiletine. Quindine increased digoxin concentration by at least 0.5 nmol/l in 21 of 22 patients. Mean serum digoxin rose from 1.2 nmol/l to 2.4 nmol/l (P < 0.001). Procainamide, disopyramide or mexiletine increased serum digoxin by 0.5 nmol/l in 1 of 41 patients. Anorexia, nausea and vomiting developed soon after starting quinidine therapy in 10 of the 22 patients who received quinidine but in only 5 of the 41 patients who received procainamide, disopyramide or mexiletine (P < 0.01). Quinidine prolonged the PR interval from 160 .+-. 14 ms to 183 .+-. 26 ms, but procainamide, disopyramide and mexiletine did not change the PR interval (P < 0.005). In digitalized patients, quinidine increases serum digoxin concentration, increases digoxin''s effect on atrioventricular conduction and produces more gastrointestinal side effects than procainamide, disopyramide or mexiletine.

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