Digoxin levels can be approximately doubled by amiodarone. Some individuals may show even greater increases. Digitalis toxicity will occur if the dosage of digoxin is not reduced appropriately.
The interaction occurs in most patients and is clearly evident after a few days but may take 4 weeks to fully develop. Reduce the digoxin dosage by between
one-third to one-half initially and monitor digoxin levels. Further adjustment of the digoxin dosage may be needed after a week or two, and possibly a month or more depending on digoxin levels. Particular care is needed in children, who may show much larger rises in digoxin levels.
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