Major
Digoxin × Dronedarone
Cardiac glycosides (digitalis)×Class III antiarrhythmic
Mechanism
Dronedarone blocks intestinal P-glycoprotein – the main route of digoxin absorption and elimination. Digoxin plasma levels rise 1.7- to 2.5-fold. Dronedarone also enhances contractile and bradycardic effects.
Symptoms
Nausea, anorexia, visual disturbances (yellow-green halos around lights), arrhythmias ranging from premature beats to ventricular tachycardia. Older adults: confusion, dizziness. Symptoms appear within 1–2 weeks of co-administration.
Management
When dronedarone starts, halve the digoxin dose; check level at 1 week. If sinus node or AV conduction symptoms appear, hold digoxin temporarily.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.