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Pharmacists' Answers to "Frequently Asked Questions" - Lanoxin

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

[posted 07/10/2000]
Question: I was diagnosed with atrial fibrilation in 1987 ( based on a one time event ). I was put on digoxin. I have never had a reoccurence of fibrilation... My digoxin blood level are very low and have always been (less then .5 ~ .08ng/ml). I have been experiencing abnormal heart beats ( ventricular). The incidence of these abnormal beats to have increased this last year... About 10 a day on bad days...These abnormal beats have been recorded on heart monitors ( the kind you wear). They occur unfrequently and can be single or clustered about 4-5 in a row... They square me... I have never had a reoccurence of atrial fibrilation... My generalist says that my digoxin blood level is so low that it's not theraputic and that I should consult with my cardiologist to possibly go off the drug. My cardiologist says to stay on it... I am a bit confused and not sure what to do....Could the digoxin be the cause of my abnormal heart beats? Please advise.

Answer: We used to use digoxin as a preventative for atrial fibrillation. Most controlled studies do not show that it works very well. But, it is one of those drugs that we still tend to use in spite of the research. It can be very toxic,but probably not in this dosage. The only way you would know if it is useful is to stop it. There is no way anyone can predict if you will get afib again. A cardiac echo showing normal chamber size might be helpful, that is if all normal, then the risk is low. Avoid excess caffeine, alcohol and lack of sleep during your trial. I'd try stopping it if it were me. But, it probably isn't the cause of your extra beats.

[posted 04/9/2000]
Question: Before I had the Maze Procedure and was cured of AF, I was on Lanoxin for several years. After being on lanoxin for about a year I developed adbominal and back pain, which became cronic after about 2 years. I was treated by different doctors, including Mayo's for IBS and other ailments for the pain. After a mistake by my druggest, I learned that the lanoxin was causing my pain, and on stopping the lanoxin, the pain also stopped after enduring it for about 6 years. This was about 7 years ago and the pain has never returned. Everyone tells me the lanoxin could not cause this symptom. Could you comment on this and also who is the manufacture of Lanoxin.

Answer: Interesting. Lanoxin is made by Glaxo-Wellcome 800-334-0089.

[posted 03/8/2000]
Question: My granddaughter lives with us and she has had several heart surgeries and after attaching her pulmonary artery to her heart and adding a valve to it, patching a hole between the chambers and they are now working on her pulmonary artery which has 2 stents at this time and very little blood going to her right lung. She will have another angioplasty soon to open up the stents a little more later this year.

This last Fall she started having CNS problems (hallucinations, depression, confusion, etc.). Recently, I read that the lanoxin she is on can have side effects and toxic levels which could be a cause of such problems. We just got a dig blood test and hope to have some results soon.

She has been on the drug almost all her life--could she have developed a sensitivity to the medication after this time?

Last summer she changed from the 1.5 mg liquid 2x day to the 1.25 tablet one time a day. Could this be contributing to her problem?

We are asking her doctor the same questions but won't be able to see him until next week. It is quite distressing for our granddaughter because it makes it very difficult for her to function. She is also running downhill--difficulty getting enough breath (sleeps on 2 pillows now) numbness in her hands, etc.

I also wonder about her lungs. Her pulmonary artery is very small and the stents are helping (they didn't even know until they finally got a stent in the right side whether or not there was an opening in the pulmonary artery.

Answer: I assume her blood oxygen levels are ok? This can also give this problem and she will eventually need supplementation. Ensure this has been checked, but by your description of the medical history I suspect this is ok. Patients get more sensitive to digoxin as they age. So that "normal" levels,particularly if in the high end of the normal range, can cause mental status problems with older patients not seen when they are younger. However, hallucinations are uncommon on digoxin-look for other causes.

[posted 02/8/2000]
Question: I have been treated for Inappropriate Sinus Tachycardia for the last 3 yrs. I recently married and had to change Dr.s because of a geographical move. The new Dr. abruptly took me off of Lanoxin .25mg. My heart rate is running 100-125 resting and 130- above for any mere activity. My Dig. blood level was only 0.5. I am constantly tired and out of breath. I will get so dizzy I pass out. My Dr. doesn't think I need the dig anymore. he says that digoxin has too many side effects. Am I nuts for wanting to go back on Lanoxin? I would like to try a permanent surgical approach, if I qualify. Can you please shed some light on this situation? Thanks so much, Julie

Answer: The digoxin is usually well tolerated if you keep your levels in the normal range. Depending on your age, evaluation by a cardiac electrophysiologist would be the next step-available in any major city. I'd restart the digoxin until you see the specialist. Your old Rx will be good for a year from date of issue.

[posted 02/2/2000]
Question: Dear Dr.
Given the dosage of the medication that I am taking,
1) Lanoxin 250mcg twice a day
2) Lipitor 20mg a day
3) Prinivil 15mg a day
4) Aspirin 83mg a day
5) Lasix 40mg a day
6) K-Dur 20mg a day
7) Toprol 50mg a day

and the side effects that I have, back pain, joint pain, nausea,sleep disorder, occasional shortness of breath, sexual dysfunction, I would like to know if their is any enteraction with these drugs that I should watch out for, should I reduce any of these doses to reduce the side effects, are their any of these that I could quit taking and which of these drugs are causing the sexual disfunction.
In Jan. of 1998 I had 5 heart bypasses. Excluding the side effects, I fell good and I'm able to perform most of my dailey functions.
I felt very good when my blood preasure was around 135-140/75-80, right now, checked at home dailey, my blood preasure runs about 120/65 my paulse runs about 60-65, my weight is 160 and has not changed in months, my height is 5' 6".
If you can help in any way, I will appreciate it. thank you very much, Jim.

Answer: The digoxin is probably responsible for the nausea. .25 mg twice a day is a huge dose, see what your blood levels are if above .15 I would try to reduce the dosage and get your blood levels towards .1 this should help the nausea. Toprol might be the culprit for the sleeping, but start with the digoxin. Digoxin is a good heart drug, but can be very toxic-this is a very high dosage.

[posted 11/23/1999]
Question: I'm male age 44, never had many drugs prescribed as a child
other than penicillan for a MVP, as an adult I only took it
or another anti-biotic prior to teeth cleaning. In July-99
that all changed as I was diagnosed with mitral valve stenosis. A heart cather confirmed mitral valve stenosis in an otherwise healthy heart, 30-jul I had them give me a St. Jude valve. They put me on Coumadin,Lopressor,Digoxin at home. 15-nov I had a Cardioversion that has worked so far and I came off the Lopressor. So my meds are currently:

Coumadin - 7.5mg (mon,thurs,sat) and 5mg (other days)
Digoxin - .25mg once per day
Prevacid - 30mg once per day (acid reflux)

My question: Prior to heart surgery, even after heart surgery I had no problem with my sexual functions, several times daily by sight or thought I would feel some response down there. I thought it was the Lopressor so I told my doctor I wanted off it, and he agreed after my Cardioversion . Since then things have become worse not better, it's as if it just hangs there limp all the time and have had a few failed attempts with my wife, that has never happened before. Even when I finally do get an errection it's not normal, it never has the complete hardnest and does not last as it did. I'm starting to panic a little. Could it be the Coumadin or Digoxin? The only other thing that has changed is that I stopped coffee just after my Cardioversion, I averaged about 4 cups per day.
Thanks, hope you have some ideas to help me.

Answer: Digoxin has a slight estrogen side effect and will cause impotence in some men(breast enlargement also). This is due to the similarities in structure between Digoxin and Estrogen. Potenially amiodarone would be useful in place of the digoxin for enough time to find out. Check with your cardiologist. There are few options for the coumadin and you'll need this one to avoid strokes. If the digoxin isn't the culprit, Viagra would be ok since you aren't on nitroglycerin and presumably have open coronary arteries.

[posted 09/25/1999]
Question: my daughter is currnetly on Lanoxin since open heart 3-99.to replace conduit and porcine valve. She had double outlet right ventrical, cub pum stenosis and pulm. stenois, vsd and transpositon of the great vessels at birth. She had numerous surgeries as well as a Rastelli at 22 months old. Will this Lanoxin have a long term effect/ She seems to be gaining weight ( thriving well) but slightly moody. Is this because of the meds. ( l baby aspirin daily also) or just because she is a girl!!!!! thank you..

Answer: Shouldn't if the levels are ok, toxic if high levels. Lanoxin has a slight estrogen like effect and she may be prone to early puberty, but there really are few other alternatives to this medication.

[posted 10/14/1999]
Question: I have been on Lanoxin, .125mg and .25mg for the past 13 mos. for Tachycardia (extreme rapid heart beats). Two pharmacists have shown concern when filling my prescriptions. They can't believe that I am on such large dosages. My lanoxin levels have been checked and appear normal. Also, since I've been on Lanoxin, I have lost 20 lbs. for no apparent reason. I eat the same as I always did. My doctor could find no reason for the weight loss. He did x-rays and blood tests and found nothing. Does this seem normal?

Answer: Depending on your weight, this wouldn't be a particularly high dosage. In general, patients above 140 pounds would need .25 and those below .125. But, this is only a start point and blood levels are the critical issue-depending on why you are taking the digoxin. The weight loss might be due to the lanoxin since decreased appetite is common. See what the blood level of the lanoxin is. In general, it should be between about .1-.2mg depending on your lab's normals. So, if it is above .15 you might be able to lower it to betweeen 0.1 and 0.15 and have less effect on your appetite.

Lanoxin [posted 8/14/98]
Question: I'm a 2nd year register nurse and I work in a hostel for the aged and disabled. A lot of the elderly are on various levels of lanoxin. I was curious as to how often blood tests to check the lanoxin levels are to be done? Is it like lithium where it gets routinely checked every so often?

Answer: It should be especially if there is any change in renal function since this would increase the drug levels. I usually check it every 6 months.

Lanoxin and Diabetes [posted 8/14/98]
Question: My father (65 years old) has been taking Lanoxin (250 mcg once per day) since the beginning of 1997 to control atrial fibrillation and by about the middle of March he began to experience tingling in hands and feet, which by December 1997 had extended to his full body. In August after a glucose tolerance test, he was diagnosed as having type 2 diabetes which is diet controllable. Is there any possibility that the tingling in the skin and so on could be Lanoxin related or Diabetes related especially when considering the speed that it has spread? Is there any possibility that the Diabetes could be Lanoxin (e.g. steroid) induced? My father's fasting glucose reading in the morning on a glucometer is around 4.9 mmol/L each morning. The only other medication my father is taking routinely is Cardiprin 100 mg - 1 pill every second day taken over many years following a cardiac infarction in 1981. He has decided to experiment by reducing the Lanoxin dosage to 125 mcg per day from the beginning of December and from January 1998 to 62.5 mcg per day, so far without any further experience of atrial fibrillation. This has so far not produced any noticeable reduction in the tingling. Other notes: On 1st of August his lipid profile was: cholesterol 6.1 mmol/L, triglycerides 4.9 mmol/L, HDL 0.4 mmol/L the LDL calculation was invalidated by the elevated triglyceride level. HDLC was 10.2. As a result, a glucose tolerance test was taken resulting in the diagnosis of diabetes. Blood glucose in this test was: fasting 6.1 mmol/L + 1 hour 12.2 mmol/L + 2 hours: 11.8 mmol/L A further cholesterol check was done on October 6th following a reduction in sugar intake giving a lipid profile of: cholesterol 4.2 mmol/L, triglycerides 2.3 mmol/L, HDL 0.6 mmol/L the LDL: 2.6 mmol/L HDLC was 7. Fasting glucose of 5.4 mmol/L. My father is concerned about the rapid spread of tingling and wonders if he is being poisoned by the Lanoxin and whether the Lanoxin produce the diabetes? Can you suggest any other references that we can use in our research?

Answer: Digoxin is a good heart drug, but can be very toxic if not watched closely. Your father can get a blood level performed which will give him an idea of how high his dosage is. It would depend a lot on his weight, renal function and some other factors. In general, large men need .25 and middle size men can sometimes take .125 mg. The digoxin would not have any effect on the sugar level.

Lanoxin and Cirrhosis [posted 7/21/98]
Question: My mother-in-law has taken Lanoxin for 12 years. She has CHF and now has been found (at 78 years of age) to have cirrhosis of the liver. She only goes to doctors for acute problems, and never has a well-checkup, but has had problems in recent years. Enough problems that we would think that a LFT would be done and elevation noted. Could the Lanoxin have contributed/caused the cirrhosis?

Answer: The lanoxin probably didn't affect the liver. However, CHF can lead to cirrhosis if there is excessive pressure on the right side of the heart leading to the liver.

Lanoxin / digoxin
Question: I am a 70 year old male. I have been on Lanoxin for the past 5 years. About 4 months ago I developed a painful left breast behind the nipple. Recently it seems to be developing into gynecomastia. I have consulted a surgeon and he says Lanoxin is implicated. He suggested I discontinue the Lanoxin. I made an appointment with my cardiologist and he says this syndrome is very rare, but has taken me off the Lanoxin. I was on the Lanoxin for an irregular heartbeat. I would appreciate any information on this matter.

Answer: Digoxin has a similar ring structure to estrogen. Both possess the same A ring (one of the steroid rings). Consequently, about 10-15% of men will develop breast development.

Question: I am currently taking 0.125 mg of Lanoxin once a day. I have been taking this dosage for more than 5 years. I believe that I also have mild gynecomastia and have recently discovered that this is a Lanoxin side effect. I am a teenager and usally this condition would just be attributed to fluctating hormone levels, but it has been present for 5 years. I am not overwieght and thus I am begining to conclude that Lanoxin is the cause. What I am wondering is whether or not this will disappear after treatment with Lanoxin is discontinued.

Answer: Digoxin is a known cause of gynecomastia . This is probably due to the similarity of structure between digoxin and estrogen (they have the same steroid A ring). Stopping the lanoxin may help. However, sometimes this is irreversible.

Question: I was released from taking Lanoxicap 0.2 in December of 1996. I am also a weight lifter. I have noticed a major decrease in my strength level since coming off of the drug. I was curious if Lanoxicap would have had an anabolic effect on me while I was taking it. I was on Lanoxicap for approximately 5 years.

Answer: Lanoxin has a steroid ring as part of its structure. It definitely has a small effect like estrogen and can be responsible for breast development in some patients. Consequently, I would not be surprised to see an effect on muscle strength and development, although I've never seen this researched.

Lanoxin and Gynecomastia
Question: I would like information regarding the likelihood of Lanoxin causing gynecomastia.

Answer: Lanoxin has similar structural characteristics to steroid hormones. This can produce estrogen effects in people taking the drug. It is not clear as to why one patient gets estrogen effects and another does not. Gynecomastia is only noted in men. Breast enlargement is less noted in women, but soreness often occurs. About 10% of men experience gynecomastia.

Lanoxin and memory loss
Question: I have been taking Lanoxin (0.25 mg each morning) for several months to regulate occasional arrhythmia. I have not noticed any side-effects, but I was recently told that lanoxin can contribute to memory loss.

Answer: Digoxin usually has nothing to do with memory loss unless the drug is given in high or toxic levels. Then the memory problem is usually reversible. See what your level is and stay on the lower side unless you continue to have arrhythmias.

Question: My mother is taking a number of different medications and I am concerned about interactions and side-effects. Can someone provide me with information on these drugs and possible problems associated with them? Also, she has recently been sleeping more and seems depressed since starting a new drug, Lanoxin. She also takes Coumadin and Diabeta and Premarin.

Answer: Lanoxin is the brand name of the drug digoxin. Your mother is probably taking Lanoxin because she has developed what is called atrial fibrillation, which is a rapid fluttering of the upper chamber of the heart. This is a dangerous condition because the blood in the atrium is not moving rapidly through the heart and thus may form tiny clots. These clots can lodge in the lungs, brain or other parts of the body and cause significant damage. Your mother has been prescribed Coumadin (warfarin) to help prevent such clots from forming.

Sleepiness and depression can indeed be caused by Lanoxin. Such side-effects can be an expected result of taking Lanoxin, but they can also be signs of dangerously high levels of the drug. It is therefore very important that you tell your motherís doctor about these symptoms at once if you have not done so already.

Lanoxin is not likely to interact with any of the medications you list with the possible exception of DiaBeta (glyburide). Your mother is taking this medication in order to lower her blood sugar level. Drugs similar to DiaBeta have been known to increase blood levels of Lanoxin. Since your mother apparently began taking Lanoxin after she was already taking DiaBeta this is not likely to be a problem. It is important to be sure her doctor knows she is taking DiaBeta if he/she does not know this already.

Lanoxin, Coumadin and DiaBeta are all potent drugs which can be very beneficial but require careful monitoring. Although used to treat heart rhythm problems, too much Lanoxin can ironically cause such problems as well. If her pulse falls below 60 her doctor should be notified.

Since Coumadin works by preventing blood from clotting, too much of this drug may lead to uncontrolled bleeding. Such bleeding often happens in the stomach or intestine. Thus she should be on the lookout for tarry stool which might indicate such bleeding.

An excessive dose of DiaBeta might cause your motherís blood sugar level to drop too low. This might cause weakness, sweating, tremor or rapid heart beat.

Her doctor should be regularly performing lab work to determine the blood level of Lanoxin and running other teus ito insure that the Coumadin and DiaBeta are working properly.

There are several useful articles on stroke, atrial fibrillation and diabetes which can be found in the "Heart and Stroke Guide" of the "Medical Reference and Study" area of the Drug Infonet site.

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