Vitamin D and digoxin

[Brainfoglady]

Firstly- thank all of you who answered my “scared of meds” post. All the responses were positive regarding taking digoxin for my AF. One more thing concerns me - I have always been vit D deficient and have mild osteoporosis. Dr ignores the deficit and I have been supplementing 1000iu for years. Due to covid 19 I’ve doubled this to boast my immunity. The literature states that vit D reacts with digoxin. If I ask my GP he’s says it a low dose and should be fine. I have to protect my bones and want to alleviate my horrid AF. Anyone had experience of taking vit D and digoxin?

[Hidden]

you need to speak to a GP or pharmacist on this one I'm afraid as we're not medically trained.

However, from the NHS website

"What happens if I take too much vitamin D?

Taking too many vitamin D supplements over a long period of time can cause too much calcium to build up in the body (hypercalcaemia). This can weaken the bones and damage the kidneys and the heart.

If you choose to take vitamin D supplements, 10 micrograms a day will be enough for most people.

Do not take more than 100 micrograms of vitamin D a day as it could be harmful. This applies to adults, including pregnant and breastfeeding women and the elderly, and children aged 11 to 17 years.

Children aged 1 to 10 years should not have more than 50 micrograms a day. Infants under 12 months should not have more than 25 micrograms a day.

Some people have medical conditions that mean they may not be able to safely take as much. If in doubt, you should consult your doctor.

If your doctor has recommended you take a different amount of vitamin D, you should follow their advice.

You cannot overdose on vitamin D through exposure to sunlight. But always remember to cover up or protect your skin if you're out in the sun for long periods to reduce the risk of skin damage and skin cancer."

[Brainfoglady in reply to Hidden]

I’m sure that information is correct for “normal” people but I have been taking Vit D for years because - even though I eat a very healthy diet and am outside most days - my blood tests always come back abnormally low. Even a few weeks ago. It’s strange but true. I have to have vit B12 injections every 3 - 4 weeks because I’m dangerously low on that also. Some sort of metabolic or malabsorption disorder is suspected. NHS doesn’t investigate such things. Thank you for the info - I will put it to my GP, but he doesn’t understand my health issues. His standard response is “it’s a low dose.”

[Auriculaire in reply to Brainfoglady]

I don't believe for one moment it is correct for "normal people". 400iu is a tiny amount of vit D and it is stupid advice like this that maintains a large proportion of the UK population in deficiency with all the health problems that this can entail. Particularly the BAME fraction. It is impossible for them to make sufficient vit D in their skins in the UK climate . I do not think it is a coincidence that they are suffering disproportionately from covid 19. It has been shown by vit D researchers that sufficient vit D helps guard against respiratory disease including that induced by bacteria and viruses. It is just not possible to make vit D between mid september and early April anywhere in the UK for anyone . Michael F Holick is one of the world's foremost vit D researchers. He and others take 4/5 000iu a day in winter and up it to 10,000 iu at the first sign of a cold or flu. They have said over and over again that these recommended doses are far too low.

[Brainfoglady in reply to Auriculaire]

I didn't recommend any amount Auriculaire - I was trying to answer Mikee69 response in a polite way to MY worries about MY vit d deficiency in spite of taking large supplements.

I notice that your response was to me - yet you left out the fact that the advise was passed on from a well meaning person to me - and he had quoted it from the NSH Website.

You are obviously an expert on Vit d - perhaps you could shed some light on the fact that I am always deficient in spite of taking 2000iu daily.

I am fearful of taking digoxin with large supplements of Vitamin D - This was my post.

I’m not an expert on Vit D and certainly wouldn’t dream of giving advice - especially stupid advise

Thank you so much for your kind response

[Auriculaire in reply to Brainfoglady]

Sorry Brainfoglady - I was referencing the Mikee69 post and in no way meant to imply that you had advised the 400iu a day.

I am not an expert on vit D. I am a person who was diagnosed with a deficiency in 2007 and decided to do some research into it. My deficiency was quite bad despite eating plenty of the few foods that contain vit D ( oily fish nearly every day),taking cod liver oil supplement and a calcium supplement with this 400iu of vit D in it. I live in a part of France well below the Loire that gets plenty sun and as a keen gardener spend a lot of time outdoors. BUT I have a fair skin and did not sunbathe . When gardening I wore a t shirt with elbow length sleeves and trousers. I went to my doc because for several months I had pain in my left thigh and it got to the stage that I could barely walk. He ordered a vit D test et voila . He prescribed an ampoule of 200,000 iu and within 4 days the pain was gone. I had several more ampoules at the start of winter but found they were not the solution. The levels would drop . In between I would take supplements. I could not maintain a level in the normal range on 3000iu a day unlike my husband who achieved a good level on this dose. Eventually I said to my GP I would try the daily drops he had suggested as an alternative to the seasonal loading ampoules. Now these drops are not cholecalciferol . They are calcifediol which is what the liver transforms cholecalciferol into. The kidneys then turn calcifediol into calcitriol. They are 5 times as potent as cholecalciferol. They work very well for me and I can only assume that my liver just was not working as well as it should in processing the vit D. Or that because I am overweight I needed a much higher dose. Obese people and dark skinned people need more vit D. The fat tissue stores it and apparently does not release it for the body to use. Now I don't know why you are always deficient on 2000iu a day but I would guess that you just need more. It is a very low dose .Individual requirements vary widely. By the way if you are deficient by UK standards then you are very deficient by French standards because the UK has abyssmally low levels for what is considered as adequate . I don't know anything about the reactions between digoxin and vit D . Maybe a pharmacist would be able to give an idea of the amount of vit D you could safely take . Without the digoxin most vit D researchers would say many women need 5,000 iu a day to maintain a decent year round level. Have you considered a UVB lamp?

[Brainfoglady in reply to Auriculaire]

Thank you so much Auriculaire - that all make sense.

I am very low on b12 and need injections every 3 weeks. I had to fight for these as the the mantra for b12 deficiency from all medics in uk is that “you don’t have pernicious anaemia and you store 12 months supply of b12 in your liver.”

Well I obviously don’t - as my body/brain becomes catatonic after 3 weeks. Both vit D and b12 are stored in the liver. The two deficiencies are frequently found together. I will try the pharmacist with my queries about vit d and digoxin. I have calcichew for my osteoporosis with contains also a small amount of D3. Calcium & vit D are on the reactive list for digoxin so s/he will be the person to ask. I am also fair but my arms and lowers legs get the sun in summer - it makes no difference to my vit d levels.

We all go out to clap for the NHS every Thursday evening and they are doing their best in this pandemic - but you are correct their deficiency criteria for many things is abysmal and some Medics are rigid/closed to fresh ideas. Thank you again - I’ve some food for thought now. Keep save in this pandemic.

[Auriculaire in reply to Brainfoglady]

I'm afraid arms and lower legs won't make that much. The torso should be exposed. Also age counts. A 70 year old skin makes only a third of a 20 year old. If you are taking a statin you can't make enough because cholesterol is needed for the manufacture of D3 and anybody using sun cream -no chance. I do not think the drops I get prescribed are available in the UK. They work really well. Each drop is supposed to be only 200iu and I take 3 drops a day normally. I can maintain a level of125- 150 nmol / l easily on that. I have upped my dose to 4 drops with this covid threat. It has been discovered that vit D can modulate the immune system and help prevent cytokine storm. I have read that softgels are better absorbed than hard tablets but don't know if that is true. I have never tried them. I used to take Calcichew when we lived in the UK.

[Seawalk]

From the Linus Pauling institution - “induction of hypercalcemia by toxic levels of vitamin D may precipitate cardiac arrhythmia in patients on digoxin (Lanoxin) (328). Hypercalcemia may also reduce the effectiveness of verapamil (Calan) and diltiazem (Cardizem) in atrial fibrillation (328)”.

LPI do recommend keeping serum levels between 30 -60mg/nl.

So as others said check it out with your health care team.

I also had servers deficiency a few years ago so have to have a maintenance dose. I take oral spray D3 (Cholecalciferol) but I am not on any contraindicated drugs Make sure you have good levels on Magnesium to maintain homeostasis.

[Brainfoglady in reply to Seawalk]

Thank you for that Seawalk - this is complicated!

[Auriculaire in reply to Brainfoglady]

You have to take enormous amounts of vit D to become toxic . I think as long as you get your calcium levels checked regularly you would be ok to up your dose quite a bit. Of course you would have to persuade your doc that you should have the blood tests.

[Seawalk]

Sorry to make it sound complicated. 😐. Just have your serum levels check to avoid toxic levels because you are on digoxin. It’s so important to have good levels of Vit d. Along with magnesium and other nutrients. Best wishes.

[Brainfoglady in reply to Seawalk]

Not you Seawalk - you were clear - I meant the whole subject of clashing meds when you have several health issues. Keep save.

[Palpman]

A check on the Medscape app for interactions between vitamin D and digoxin shows that the vitamin depletes potassium and causes hypokalemia.

This in turn reduces the action of digoxin and can cause arrhythmia.

So eat more potatoes and bananas.

For info on drugs and drug interactions download MedScape app for android or apple.

For info on drugs that can cause LQTS, Torsades de Pointes and drug interactions that can precipitate the aforementioned download CredibleMeds app.

[Jill13]

Yes I have taken both for years with no apparent side effects. In fact my doctor recommended Vit D as said we older people do not get it from sun exposure as do younger people