Why the study?
Does intravenous diltiazem cause fatal bradycardia in patients with hyperkalemia and suspected digoxin toxicity?
Does intravenous diltiazem cause fatal bradycardia in patients with hyperkalemia and suspected digoxin toxicity?
Concomitant administration of intravenous diltiazem and digoxin may be dangerous and potentially fatal in patients with hyperkalemia or suspected digoxin toxicity.
IV diltiazem may precipitate fatal bradycardia in hyperkalemic patients with suspected digoxin toxicity; single case leaves open need for safety studies.
Progressive, sustained bradycardia resulting in asystole and subsequent death is reported in a 70-year-old woman with hyperkalemia and suspected digoxin toxicity following a 0.25 mg/kg intravenous diltiazem dose for treatment of atrial fibrillation with a rapid ventricular response. The possible pharmacodynamic and pharmacokinetic interactions between diltiazem, digoxin, and an elevated plasma potassium concentration are discussed and related to the outcome of the case. The routine practice of concomitant administration of diltiazem for rapid ventricular rate control and digoxin for long-term control may be dangerous in a subset of patients.
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Moser et al. (1996) studied this question.
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