digoxin and Anorexia

A 27 year old female with a complex history of congenital heart disease, cardiac surgery, heart failure, and arrhythmias was admitted for a Pseudomonas aeruginosa sternal wound infection and treated with intravenous antibiotics. After discharge and completion of an outpatient course of intravenous antibiotics, suppressive antibiotic therapy with ciprofloxacin was initiated. She presented to clinic with nausea and anorexia within a few days of addition of ciprofloxacin to her current regimen of medications, which included digoxin. The digoxin was discontinued, with all other medications remaining the same, and the symptoms resolved in 48 h. The dose of digoxin was restarted at 50 % of the previous dose with no further complications. The proposed cause of the nausea and anorexia was digoxin toxicity secondary to a drug-drug interaction with ciprofloxacin.. Patients receiving ciprofloxacin and digoxin should be monitored closely for the risk of digoxin toxicity.

Topics: Adult; Anorexia; Anti-Bacterial Agents; Cardiotonic Agents; Ciprofloxacin; Digoxin; Drug Interactions; Drug Monitoring; Female; Heart Failure; Humans; Nausea; Pacemaker, Artificial; Pseudomonas aeruginosa; Pseudomonas Infections; Reoperation; Surgical Wound Infection; Treatment Outcome

A case of digoxin poisoning following the co-administration of digoxin and clarithromycin in a 28 year old male is described. Since the aetiology of chronic digoxin poisoning is often unclear, clinicians should be aware of the potential drug-drug interaction between digoxin and clarithromycin.

Topics: Adult; Anorexia; Anti-Arrhythmia Agents; Anti-Bacterial Agents; Clarithromycin; Digoxin; Drug Interactions; Drug Therapy, Combination; Emergency Service, Hospital; Humans; Male; Vomiting

A case of anorexia, paranoid delusions, and lethargy associated with digoxin toxicity is presented here. The digitalis glycosides are among the most commonly used drugs in modern medicine, and as such, they frequently cause toxicity. Although cardiac side effects of digoxin are well recognized, less attention has been paid to potential CNS effects. Psychiatric manifestations, from calm disorientation to violent psychosis, tend to occur more often in elderly patients and may be the earliest or only sign of digitalis toxicity.

Topics: Aged; Anorexia; Delirium; Digoxin; Female; Humans; Paranoid Disorders; Sleep Stages

The status of the erythrocyte sodium pump was evaluated in a group of patients suffering from anorexia nervosa and a group of healthy female control subjects. Anorectic patients showed significantly higher mean values of digoxin-binding sites/cell (ie, the number of Na-K-ATPase units) with respect to control subjects while no differences were found in the specific 86Rb uptake (which reflects the Na-K-ATPase activity) between the two groups. A significant correlation was found between relative weight and the number of Na-K-ATPase pump units (r = -0.66; P less than 0.0001). Anorectic patients showed lower serum T3 concentrations (71.3 +/- 53 ng/dL) with respect to control subjects (100.8 +/- 4.7 ng/dL; P less than 0.0005) and a significant negative correlation between T3 levels and the number of pump units (r = -0.52; P less than 0.003) was found. Our study therefore shows that the erythrocyte Na-K pump may be altered in several anorectic patients. We suggest that this feature could be interrelated with the degree of underweight and/or malnutrition.

Topics: Adolescent; Adult; Anorexia; Digoxin; Erythrocytes; Feeding and Eating Disorders; Female; Humans; Potassium; Radioisotopes; Receptors, Drug; Rubidium; Sodium; Sodium-Potassium-Exchanging ATPase; Thyroid Hormones

In a review of the records of 81 patients with the discharge diagnosis of digitalis toxicity, I found a preponderance of very old patients, many of whom had anorexia, nausea, and prerenal azotemia. Arrhythmias were common (93%) and reflected enhanced automaticity, enhanced AV block, or both. Atrial fibrillation with complete heart block and a regular junctional rhythm should particularly elicit suspicion of digitalis toxicity. Atrial tachycardia with block is less specific and less frequent.

Topics: Adult; Age Factors; Aged; Anorexia; Arrhythmias, Cardiac; Atrial Fibrillation; Digitalis; Digoxin; Heart Atria; Heart Block; Humans; Middle Aged; Nausea; Plants, Medicinal; Plants, Toxic; Radioimmunoassay; Tachycardia; Uremia

We compared the effects of quinidine and three alternate antiarrhythmic drugs on serum digoxin concentration in 63 patients before and during administration of quinidine, procainamide, disopyramide, or mexiletine. Quinidine 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 less than 0.001). Procainamide, disopyramide, or mexiletine increased serum digoxin by 0.5 nmol/L in one of 41 patients. Anorexia, nausea, and vomiting develop soon after starting quinidine therapy in 10 of the 22 patients who received quinidine but in only five of the 41 patients who received procainamide, disopyramide, or mexiletine (P less than 0.01). Quinidine prolonged the PR intervals from 160 +/- 14 ms to 183 +/- 26 ms, but procainamide, disopyramide, and mexiletine did not change the PR interval (P less than 0.005). In digitalized patients, quinidine increases serum digoxin concentration, increases digoxin's effect on atrioventricular conduction, and produces more adverse gastrointestinal effects than procainamide, disopyramide, or mexiletine.

Topics: Aged; Anorexia; Anti-Arrhythmia Agents; Digoxin; Disopyramide; Drug Interactions; Female; Humans; Male; Mexiletine; Middle Aged; Nausea; Procainamide; Prospective Studies; Quinidine; Vomiting

Topics: Aged; Anorexia; Arrhythmias, Cardiac; Deglutition Disorders; Digitalis Glycosides; Digitoxin; Digoxin; Female; Heart Failure; Humans; Male

The serum digoxin concentration increased in 25 of 27 study patients (93%), and the mean serum digoxin concentration rose from 1.4 ng/ml to 3.2 ng/ml during quinidine therapy. Anorexia, nausea, or vomiting developed in 16 patients (59%) but disappeared in all ten patients for whom the digoxin dose alone was reduced, suggesting that digoxin excess caused these symptoms. Ventricular premature depolarizations developed in three patients after starting quinidine therapy; ventricular tachycardia developed in one patient, and another died suddenly. When starting quinidine therapy in patients who are taking digoxin, the clinical course, ECG, and serum digoxin level should be followed closely.

Topics: Aged; Anorexia; Arrhythmias, Cardiac; Digoxin; Drug Interactions; Female; Humans; Male; Middle Aged; Nausea; Quinidine; Vomiting

Topics: Anorexia; Digoxin; Feeding and Eating Disorders; Humans; Nausea