Summary
An increase in serum digoxin concentration occurs in 90% of patients given quinidine. On average, the serum digoxin doubles during treatment with therapeutic doses of quinidine. Almost every patient treated with quinidine will have a decrease in the renal clearance of digoxin and many will have a decrease in the volume of distribution of digoxin. Whether changes in the inotropic effect of digoxin occur during concurrent quinidine administration is an unsettled area. However, gastrointestinal and cardiac toxicity, which closely resemble digitalis toxicity, often occur when quinidine causes the serum digoxin concentration to rise. These effects subside when the digoxin dose is reduced. Therefore it is prudent to monitor serum digoxin concentrations during concomitant quinidine treatment and to adjust the digoxin dose according to the results. When the toxicity is severe or dose adjustment is difficult, another antiarrhythmic drug should be selected.
Similar content being viewed by others
References
Chen, T.-S. and Friedman, H.S.: Alteration of digoxin pharmacokinetics by a single dose of quinidine. Journal of the American Medical Association 244: 669–672 (1980).
Dahlqvist, R.; Ejvinsson, G. and Schenck-Gustafsson, K.: Effect of quinidine on plasma concentration and renal clearance of digoxin. A clinically important drug interaction. British Journal of Clinical Pharmacology 9: 412–418 (1980).
Doering, W.: Digoxin-quinidine interaction. New England Journal of Medicine 301: 400–405 (1979).
Doherty, J.E.; Straub, K.D.; Murphey, M.L.; de Soyza, N., Bissett, J.K. and Kane, J.J.: Digoxin-quinidine interaction. Changes in canine tissue concentration from steady state with quinidine. American Journal of Cardiology 45: 1196–1200 (1980).
Ejvinsson, G.: Effect of quinidine on plasma concentrations of digoxin. British Medical Journal 1: 279–280 (1978).
Fenster, P.E.; Powell, J.R.; Graves, P.E.; Conrad, K.A.; Hager, W.D.; Goldman, S. and Marcus, F.I.: Digitoxin-quinidine interaction: Pharmacokinetic evaluation. Annals of Internal Medicine 93: 698–701 (1980).
Garty, M.; Sood, P. and Rollins, D.E.: Digitoxin elimination reduced during quinidine therapy. Annals of Internal Medicine 94: 35–37(1981).
Giardina, E.G.V.; Bigger, J.T.,Jr; Glassman, A.H.; Perel, J.M.; Roose, S.P.; Siris, S.G. and Davis, J.C.: A comparison of desmethylimipramine and imipramine on the electrocardiogram and left ventricular function: A randomized crossover design. Archives of Internal Medicine. International Journal of Cardiology (In press, 1982).
Hager, W.D.; Fenster, P.; Mayersohn, M.; Perrier, D.; Graves, P., Marcus, F.I. and Goldman, S.: Digoxin-quinidine interaction. Pharmacokinetic Evaluation. New England Journal of Medicine 300: 1238–1241 (1979).
Hirsh, P.D.; Weiner, H.J. and North, R.L.: Further insights into digoxin-quinidine interaction: Lack of correlation between serum digoxin concentration and inotropic state of the heart. American Journal of Cardiology 46: 863–867 (1980).
Holt, D.W.; Hayler, A.M.; Edmonds, M.E. and Ashford, R.F.V.: Clinically significant interaction between digoxin and quinidine. British Medical Journal 4: 1401 (1979).
Hougen, T.J. and Smith, T.W.: Inhibition of myocardial monovalent cation active transport by subtoxic doses of ouabain in the dog. Circulation Research 42: 856–863 (1978).
Keller, F. and Kreutz, G.: Chinidin interaktion mit digitoxin. Deutsche Medizinische Wochenschrift 105: 701–702 (1980).
Lang, R.; Klein, H.O.; Weiss, E.; Libhaber, C. and Kaplinsky, E.: Effect of verapamil on blood level and renal clearance of digoxin. Circulation 62(Suppl. 3): 111–83 (1980).
Leahey, E.B.,Jr; Reiffel, J.A.; Drusin, R.E.; Heissenbuttel, R.H.; Lovejoy, W.P. and Bigger, J.T.,Jr: Interaction between digoxin and quinidine. Journal of the American Medical Association 240: 533–534(1978).
Leahey, E.B.,Jr; Reiffel, J.A.; Heissenbuttel, R.H.; Drusin, RE.; Lovejoy, W.P. and Bigger, J.T.,Jr: Enhanced cardiac effect of digoxin during quinidine treatment. Archives of Internal Medicine 139: 519–521 (1979).
Leahey, E.B.,Jr; Reiffel, J.A.; Giardina, E.G.V. and Bigger, J.T., Jr: The effect of quinidine and other oral antiarrhythmic drugs on serum digoxin. A prospective study. Annals of Internal Medicine 92: 605–608 (1980a).
Leahey, E.B.,Jr; Hougen, T.J.; Bigger, J.T., Jr and Smith, T.W.: Effect of quinidine on digoxin-inhibited monovalent cation active transport (abstr.). Circulation 62: III–258 (1980b).
Leahey, E.B.,Jr; Bigger, J.T., Jr; Butler, V.P., Jr; Reiffel, J.A.; O’Connell, G.C.; Scaffidi, L.E. and Rottman, J.N.: Quinidine-digoxin interaction. Time course and pharmacokinetics. American Journal of Cardiology. 48: 1141–1146 (1981).
Leahey, E.B.,Jr; Giardina, E.G.V. and Bigger, J.T.,Jr: Personal communication.
Moench, T.R.: The quinidine-digoxin interaction (corresp.). New England Journal of Medicine 302: 864 (1980).
Moysey, J.O.; Jaggarao, N.S.V.; Grundy, E.N. and Chamberlain, D.A.: Amiodarone increases plasma digoxin concentrations. British Medical Journal 282: 272–273 (1981).
Mungall, D.R.; Robichaux, R.P., Perry, W.; Scott, J.W.; Robinson, A.; Burelle, T. and Hurst, D.: Effects of quinidine on serum digoxin concentration. Annals of Internal Medicine 93: 689–693(1980).
Ochs, H.R.; Pabst, J.; Greenblatt, D.J. and Dengler, H.J.: Noninteraction of digitoxin and quinidine. New England Journal of Medicine 303: 672–674 (1980).
Pedersen, K.E.; Hastrop, J. and Hvidt, S.: The effect of quinidine on digoxin kinetics in cardiac patients. Acta Medica Scandinavica 207: 291–295 (1980).
Peters, U.; Risler, T.; Grabensee, B.; Falkenstein, U. and Kroukou, J.: Interaktion von chirridin und digitoxin beim menschen. Deutsche Medizinische Wochenschrift 105: 438–442(1980).
Reid, P.R. and Meek, A.G.: Digoxin-Quinidine Interaction. Johns Hopkins Medical Journal 145: 227–229 (1979).
Schenck-Gustafsson, K. and Dahlqvist, R.: Pharmacokinetics of digoxin in patients subjected to the quinidine-digoxin interaction. British Journal of Clinical Pharmacology 11: 181–186 (1981).
Smith, T.W. and Wagner, H., Jr: Effects of Na,K-ATPase-specific antibodies on enzymatic activity and monovalent cation transport. Journal of Membrane Biology 25: 341–360 (1975).
Smith, T.W.; Haber, E.; Yeatman, L. and Butler, V.P., Jr: Reversal of advanced digoxin intoxication with Fab fragments of digoxin-specific antibodies. New England Journal of Medicine 294: 797–800 (1976).
Somberg, J.C. and Smith, T.W.: Localization of the neurally mediated arrhythmogenic properties of digitalis. Science 204: 321–323(1980).
Steiness, E.; Waldorff, S.; Hansen, P.B.; Kjaergard, H.; Buch, J. and Edgblad, H.: Reduction of digoxin-induced inotropism during quinidine administration. Clinical Pharmacology and Therapeutics 27: 791–795 (1980).
Storstein, L.; von der Lippe, A.; Amlie, J. and Storstein, O.: Is there an interaction between digitoxin and quinidine? Circulation 59 and 60 (Suppl. 2): II–230 (1979).
Wandell, M.; Powell, J.R.; Hager, W.D.; Fenster, P.E.; Graves, P.E.; Conrad, K.A. and Goldman, S.: Effect of quinine on digoxin kinetics. Clinical Pharmacology and Therapeutics 28: 425–430 (1980).
Warner, N.J.; Leahey, E.B.,Jr and Bigger, J.T.,Jr: Effect of quinidine on the steady-state tissue concentration of digoxin in dogs. Circulation. American Journal of Cardiology 49: 1026 (1982)
Wellens, H.J.J.; Gorgels, A.P., Braat, S.J., Bar, F.W.; Vanagt, E.-J. and Phaf, B.: Effect of oral disopyramide on serum digoxin levels. A prospective study. American Heart Journal 100: 934–935 (1980).
Author information
Authors and Affiliations
Additional information
Dedicated to the memory of Dr Edward B. Leahey Jr.
Rights and permissions
About this article
Cite this article
Bigger, J.T., Leahey, E.B. Quinidine and Digoxin. Drugs 24, 229–239 (1982). https://doi.org/10.2165/00003495-198224030-00003
Published:
Issue Date:
DOI: https://doi.org/10.2165/00003495-198224030-00003