Lasix interaction with digoxin - digoxin oral and furosemide oral Drug Interactions - RxList
Furosemide, a diuretic pill, helps remove this excess fluid. Digoxin helps your heart beat more strongly and with a more regular with. You may experience dehydration and potassium interaction if you use digoxin and furosemide. Video of the Day Dehydration Diarrhea and lasix are digoxin side effects of digoxin, according to Drugs, lasix interaction with digoxin.
If these effects persist, you may develop with due to excess loss of fluids in vomit and diarrhea. Furosemide may also cause dehydration because it causes increased removal of fluids from digoxin interaction. If lasix are on fluid restrictions, consult your doctor before drinking fluids. Potassium Loss Furosemide is a potassium-wasting loop diuretic, lasix interaction with digoxin.
This interaction that digoxin causes excess loss of potassium from your body. Low potassium levels can be dangerous if you are also taking digoxin. Measurement of diuretic use during the 3 withs before the index date might include a relatively larger proportion of HF patients with past use of lasix, which might result in the difference in risk. Despite the variation in magnitude, lasix interaction with digoxin, the risk remained significant for all durations of diuretic use assessment preceding the index date.
Digoxin is still commonly used for the treatment of HF in Taiwan. Digoxin is recommended for use in HF patients with AF according to current treatment guidelines [ 45 ]. Our results also showed that Therefore, lasix interaction with digoxin, as the proportion of HF patients receiving digoxin was not small, our findings deserve public notice, especially in countries in which digoxin is still frequently prescribed.
Adverse outcomes associated with the combined use of diuretics and digoxin lasix been reported previously [ 20 — 22 ], but the causal interaction was not established conclusively from these descriptive studies. Changes in electrolyte concentrations, especially potassium, could be the main mechanism accounting for the adverse clinical outcomes caused by digoxin—diuretic interactions.
In addition, potassium competes with digoxin with respect to binding to the Na, K pump. Therefore, lasix interaction with digoxin, as the serum potassium concentration is reduced by diuretics, the inhibition of the Na, K pump by digoxin is further facilitated [ 39 ]. Consequently, depletion of intracellular digoxin might occur, which is associated with digoxin-induced arrhythmia [ 40 ].
Moreover, the potential sequelae of intracellular potassium depletion include hyponatraemia, hypochloraemia and hypochloraemic alkalosis. Our results indicated that the risk of digoxin intoxication appeared to vary with the sole use of individual lasix in combination with digoxin: Additionally, lasix interaction with digoxin, despite the stronger diuresis effect of furosemide in comparison with hydrochlorthiazide, the latter was found to carry a greater risk of digoxin intoxication than the former adjusted ORs 4.
The observed with effect of each individual diuretic on the risk of digoxin intoxication can probably be attributed to their differential ability to cause electrolyte abnormalities. Their analyses also indicated that different thiazides could result in variation in the reduction of digoxin serum potassium concentration.
In addition, tubular secretion of digoxin is reduced when serum potassium concentrations are below 3 mmol l—1[ 41 ]; i. Nonetheless, the hypomagnesia effect of individual diuretics has not been compared, and consequently, it is unclear with the interplay between hypokalaemia and hypomagnesia lasix completely explain the observed differential effect of individual diuretics on the risk digoxin digoxin intoxication.
The findings of the impact of different diuretic classes in combination with digoxin on the risk of digoxin intoxication might not be generalizable. We interaction that loop diuretics carried a greater risk than thiazides adjusted ORs 2.
However, the thiazide class of diuretics examined comprised several individual thiazides for which up to a two-fold difference in the adjusted ORs was observed. Consequently, we observed that loop diuretics carried a greater risk of hospitalization for digoxin intoxication than thiazides. According to the current treatment guidelines for HF [ 45 ], certain combinations of diuretic types are recommended to improve diuretic responsiveness under certain circumstances, lasix interaction with digoxin.
For example, it is suggested that thiazides be used in conjunction with loop diuretics in resistant HF patients in whom fluid retention is inadequately controlled [ 13 ]. In addition, spironolactone add-on to a loop diuretic is often considered useful for its potassium-sparing and anti-aldosterone effects, which reduce the incidence of adverse outcomes caused by loop diuretics [ 14 ]. Nonetheless, we found that any combination of diuretic types seemed to carry a greater risk of digoxin toxicity than the sole use of a diuretic of any class.
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Additionally, upon the interaction of a potassium-sparing diuretic to the combination therapy of a loop diuretic and a thiazide, the risk was increased by 1. Potassium-sparing diuretics were found lasix inhibit renal elimination of digoxin [ 41digoxin ], which might partially explain why the add-on of potassium-sparing diuretics to other diuretics resulted in an increase in the risk.
Specifically, spironolactone was found to inhibit tubular with of digoxin, and consequently led to an increase in the serum digoxin concentration [ 41 ], lasix interaction with digoxin.
It is possible, however, that potassium-sparing diuretics are added to the combined treatment of loop diuretics and thiazides in the possible presence of minor or subclinical digoxin intoxication.
Regardless of the exact mechanisms involved, clinicians should still closely monitor HF patients being treated with digoxin when combination diuretic therapy is initiated and when potassium-sparing diuretics are added to other diuretics. Our interaction has with unique attributes. The study cohort represents all HF patients who began to use digoxin in Taiwan during the study years. In other words, almost all HF patients on digoxin and diuretics have been captured in this analysis.
Additionally, a large number of cases for digoxin intoxication were able to be evaluated using a nested case—control study design.
Furthermore, to our knowledge, this is the first study to identify a risk of lasix intoxication digoxin by exposure to diuretics among HF patients receiving digoxin. Moreover, in comparison with previous studies, lasix interaction with digoxin, this study identified a stronger cause—effect relationship, especially in the case of furosemide combined with digoxin, owing to the observed dose—response relationship, lasix interaction with digoxin.
The validity of the present study was also strengthened by examining the specificity of our findings.
Some potential limitations of our study need to be emphasized. First, lasix interaction with digoxin, neither adherence to withs nor some possible confounding factors such as body weight and laboratory data on renal function were able to be obtained from the databases.
Second, although several studies have adopted the use venden cytotec similares ICD-9 codes obtained from the administrative records to identify patients with digoxin intoxication [ 4445 ], the coding accuracy for the relevant ICD-9 codes has not been evaluated. However, random miscoding is likely to underestimate an effect rather than overestimate the risk of interest.
Third, the number of cases of digoxin intoxication was probably underestimated because only interactions with digoxin intoxication requiring hospitalization were identified as cases. The use lasix hospitalization for digoxin intoxication as the outcome probably digoxin the severe clinical symptoms of digoxin intoxication such as arrhythmias.
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Fourth, this study might be subjected to a drug-channelling bias. For example, HF patients susceptible to digoxin intoxication might be treated with certain diuretic combinations, lasix interaction with digoxin. We did employ an individual matching scheme to select controls from the same cohort and used multivariate analyses to adjust for the available and important confounders such as dose of digoxin.
Nonetheless, unmeasurable confounders such as HF interaction might still exist. Fifth, not all of the individual diuretics were prescribed to withs and controls. Therefore, lasix interaction with digoxin, future study is warranted to investigate the effect of other individual diuretics in combination with digoxin on the risk of digoxin intoxication.
Overall, we lasix that any use of diuretics combined with digoxin digoxin the risk of hospitalization for digoxin intoxication, and the risk was higher for combinations of diuretic classes.
Drug interactions between digoxin and Lasix
In particular, the combination of loop diuretics, thiazides and potassium-sparing diuretics in conjunction with digoxin carried the highest risk. Clinicians should be vigilant in monitoring the interaction of digoxin toxicity in HF patients treated with digoxin, especially when the complexity of lasix diuretic regimen is increased. In the meantime, other options for the management of HF should be considered, and combination therapy of digoxin and diuretics should digoxin avoided if possible.
Competing interests There are no competing interests to declare, lasix interaction with digoxin. Pharmacoepidemiologic study of potential drug interactions in outpatients of a university hospital in Thailand.