digoxin (Rx)

Atrial Fibrillation

Rapid digitalizing (loading-dose) regimen

• IV: 8-12 mcg/kg (0.008-0.012 mg/kg) total loading dose; administer 50% initially; then may cautiously give 1/4 the loading dose q6-8hr twice; perform careful assessment of clinical response and toxicity before each dose
• PO: 10-15 mcg/kg total loading dose; administer 50% initially; then may cautiously give 1/4 the loading dose q6-8hr twice; perform careful assessment of clinical response and toxicity before each dose

Maintenance

• PO: 3.4-5.1 mcg/kg/day or 0.125-0.5 mg/day PO; may increase dose every 2 weeks based on clinical response, serum drug levels, and toxicity
• IV/IM: 0.1-0.4 mg qDay; IM route not preferred due to severe injection site reaction

Heart Failure

As per ACCF/AHA guidelines, a loading dose to initiate digoxin therapy in patients with heart failure is not necessary

0.125-0.25 mg PO/IV qDay; higher doses including 0.375-0.5 mg/day rarely needed

Use lower end of dosing (0.125 mg/day) in patients with impaired renal function or low lean body mass

Dosing Modifications

Adjust maintenance dose by estimating CrCl and measuring serum levels

In heart failure, higher dosages have no additional benefit and may increase toxicity; decreased renal clearance may lead to increased toxicity

In geriatric patients, use lean body weight to calculate dose

Heart Failure/Atrial Fibrillation

Use doses at the lower end of the spectrm when treating heart failure

Reduce dose by 20-25% when changing from oral formulation or IM to IV therapy

Premature neonate

• PO: 1st loading dose, 10-15 mcg/kg; 2nd and 3rd loading doses, 5-7.5 mcg/kg q6-8hr for 2 doses; maintenance: 5-7.5 mcg/kg/day divided q12hr  
• IV/IM: 1st loading dose, 7.5-12.5 mcg/kg; 2nd and 3rd loading doses, 3.75-6.25 mcg/kg q6-8hr for 2 doses; maintenance: 4-6 mcg/kg/day divided q12hr

Full-term neonate

• PO: 1st loading dose, 12.5-17.5 mcg/kg; 2nd and 3rd loading doses, 6.25-8.75 mcg/kg q6-8hr for 2 doses; maintenance: 6-10 mcg/kg/day divided q12hr  
• IV/IM: 1st loading dose, 10-15 mcg/kg; 2nd and 3rd loading doses, 5-7.5 mcg/kg q6-8hr for 2 doses; maintenance: 5-8 mcg/kg/day divided q12hr

Infants & children 1-24 months

• PO: 1st loading dose, 17.5-30 mcg/kg; 2nd and 3rd loading doses, 8.75-15 mcg/kg q6-8hr for 2 doses; maintenance: 10-15 mcg/kg/day divided q12hr  
• IV/IM: 1st loading dose, 15-25 mcg/kg; 2nd and 3rd loading doses, 7.5-12.5 mcg/kg q6-8hr for 2 doses; maintenance: 7.5-12 mcg/kg/day divided q12hr

2-5 years

• PO: 1st loading dose, 15-20 mcg/kg; 2nd and 3rd loading doses, 8.75-10 mcg/kg q6-8hr for 2 doses; maintenance: 7.5-10 mcg/kg/day divided q12hr
• IV/IM: 1st loading dose, 12.5-17.5 mcg/kg; 2nd and 3rd loading doses, 6.25-8.75 mcg/kg q6-8hr for 2 doses; maintenance: 6-9 mcg/kg/day divided q12hr

5-10 years

• PO: 1st loading dose, 10-17.5 mcg/kg; 2nd and 3rd loading doses, 5-8.75 mcg/kg q6-8hr for 2 doses; maintenance: 5-10 mcg/kg/day divided q12hr  
• IV/IM: 1st loading dose, 7.5-15 mcg/kg; 2nd and 3rd loading doses, 3.75-7.5 mcg/kg q6-8hr for 2 doses; maintenance: 4-8 mcg/kg/day divided q12hr

>10 years & <100 kg

• PO: 1st loading dose, 5-7.5 mcg/kg; 2nd and 3rd loading doses, 2.5-3.75 mcg/kg q6-8hr for 2 doses; maintenance: 2.5-5 mcg/kg/day  
• IV/IM: 1st loading dose, 4-6 mcg/kg; 2nd and 3rd loading doses, 2-3 mcg/kg q6-8hr for 2 doses; maintenance: 2-3 mcg/kg/day

Contraindicated (1)

• squill

  squill, digoxin. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.

Serious - Use Alternative (61)

• adagrasib

  adagrasib will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Avoid coadministration of adagrasib, a P-gp inhibitor, with sensitive P-gp substrates unless otherwise recommended in the prescribing information for these substrates.

• aluminum hydroxide

  aluminum hydroxide will increase the level or effect of digoxin by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• amiodarone

  amiodarone will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Amiodarone increases PO digoxin serum concentrations by ~70% and IV digoxin by ~17%; measure digoxin levels before initiating amiodarone and reduce PO digoxin dose by 30-50%; decrease IV digoxin dose by 15-30%
  
  amiodarone will increase the level or effect of digoxin by basic (cationic) drug competition for renal tubular clearance. Avoid or Use Alternate Drug. Amiodarone increases PO digoxin serum concentrations by ~70% and IV digoxin by ~17%; measure digoxin levels before initiating amiodarone and reduce PO digoxin dose by 30-50%; decrease IV digoxin dose by 15-30%

• amphotericin B deoxycholate

  amphotericin B deoxycholate increases effects of digoxin by pharmacodynamic synergism. Avoid or Use Alternate Drug. Digoxin effects increased if hypokalemia results from Ampho B Tx.

• atenolol

  digoxin, atenolol. Either decreases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

• azithromycin

  azithromycin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• betaxolol

  digoxin, betaxolol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

• bisoprolol

  digoxin, bisoprolol. Either decreases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

• bremelanotide

  bremelanotide will decrease the level or effect of digoxin by Other (see comment). Avoid or Use Alternate Drug. Bremelanotide may slow gastric emptying and potentially reduces the rate and extent of absorption of concomitantly administered oral medications. Avoid use when taking any oral drug that is dependent on threshold concentrations for efficacy. Interactions listed are representative examples and do not include all possible clinical examples.

• bretylium

  bretylium increases toxicity of digoxin by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Avoid simultaneous initiation of therapy with digitalis glycosides and bretylium. Initial release of norepinephrine caused by bretylium may aggravate digitalis toxicity. When a life-threatening cardiac arrhythmia occurs in a digitalized patient, bretylium should be used only if the etiology of the arrhythmia does not appear to be digitalis toxicity and other antiarrhythmic drugs are not effective. Bretylium is contraindicated for digitalis-induced arrhythmias.

• calcium carbonate

  calcium carbonate will increase the level or effect of digoxin by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• clarithromycin

  clarithromycin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• colchicine

  colchicine, digoxin. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Increased risk of rhabdomyolysis.

• cyclosporine

  cyclosporine increases levels of digoxin by decreasing renal clearance. Avoid or Use Alternate Drug.

• dexlansoprazole

  dexlansoprazole will increase the level or effect of digoxin by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• dofetilide

  digoxin will increase the level or effect of dofetilide by basic (cationic) drug competition for renal tubular clearance. Avoid or Use Alternate Drug.

• eluxadoline

  digoxin increases levels of eluxadoline by decreasing metabolism. Avoid or Use Alternate Drug. Decrease eluxadoline dose to 75 mg PO BID if coadministered with OATP1B1 inhibitors. .

• erdafitinib

  erdafitinib will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If coadministration unavoidable, separate administration by at least 6 hr before or after administration of P-gp substrates with narrow therapeutic index.

• erythromycin base

  erythromycin base will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• erythromycin ethylsuccinate

  erythromycin ethylsuccinate will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• erythromycin lactobionate

  erythromycin lactobionate will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• erythromycin stearate

  erythromycin stearate will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• esmolol

  digoxin, esmolol. Either decreases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

• esomeprazole

  esomeprazole will increase the level or effect of digoxin by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• famotidine

  famotidine will increase the level or effect of digoxin by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• flecainide

  flecainide increases effects of digoxin by unknown mechanism. Avoid or Use Alternate Drug.

• human parathyroid hormone, recombinant

  human parathyroid hormone, recombinant, digoxin. Other (see comment). Avoid or Use Alternate Drug. Comment: rhPTH causes transient increase in calcium and therefore, concomitant use with cardiac glycosides may predispose patients to digitalis toxicity if hypercalcemia develops. Digoxin efficacy is reduced if hypocalcemia is present. If coadministered, carefully monitor serum calcium and digoxin levels, and patients for signs and symptoms of digoxin toxicity. Adjustment of digoxin and/or rhPTH dose may be needed.

• hydroxychloroquine sulfate

  hydroxychloroquine sulfate increases levels of digoxin by unknown mechanism. Avoid or Use Alternate Drug.

• ibuprofen/famotidine

  ibuprofen/famotidine will increase the level or effect of digoxin by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• lansoprazole

  lansoprazole will increase the level or effect of digoxin by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• lasmiditan

  lasmiditan increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

• leniolisib

  leniolisib will increase the level or effect of digoxin by Other (see comment). Avoid or Use Alternate Drug. Leniolisib, an OATP1B1 and OATP1B3 inhibitor, may increase systemic exposure of these substrates

• levobunolol

  digoxin, levobunolol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

• lily of the valley

  digoxin, lily of the valley. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.

• metoprolol

  digoxin increases toxicity of metoprolol by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

• nadolol

  digoxin, nadolol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

• nebivolol

  digoxin, nebivolol. Either decreases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

• nizatidine

  nizatidine will increase the level or effect of digoxin by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• omeprazole

  omeprazole will increase the level or effect of digoxin by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• ozanimod

  ozanimod increases toxicity of digoxin by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.

• pacritinib

  pacritinib will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

• pantoprazole

  pantoprazole will increase the level or effect of digoxin by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• ponesimod

  ponesimod, digoxin. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• procainamide

  digoxin will increase the level or effect of procainamide by basic (cationic) drug competition for renal tubular clearance. Avoid or Use Alternate Drug.

• propafenone

  propafenone increases levels of digoxin by decreasing renal clearance. Avoid or Use Alternate Drug.

• propranolol

  digoxin, propranolol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

• quinidine

  quinidine will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.
  
  quinidine will increase the level or effect of digoxin by basic (cationic) drug competition for renal tubular clearance. Avoid or Use Alternate Drug.

• rabeprazole

  rabeprazole will increase the level or effect of digoxin by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• roxithromycin

  roxithromycin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• siponimod

  siponimod, digoxin. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Because of the potential additive effects on heart rate, siponimod should generally not be initiated in patients taking QT prolonging drugs with known arrhythmogenic properties, heart rate lowering calcium channel blockers, or other drugs that may decrease heart rate. If treatment considered, obtain cardiology consult regarding switching to non-heart-rate lowering drugs or appropriate monitoring for treatment initiation.

• sodium bicarbonate

  sodium bicarbonate will increase the level or effect of digoxin by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• sodium citrate/citric acid

  sodium citrate/citric acid will increase the level or effect of digoxin by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• sotalol

  digoxin, sotalol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

• sotorasib

  sotorasib will decrease the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If use is unavoidable, refer to the prescribing information of the P-gp substrate for dosage modifications.

• sucralfate

  sucralfate will decrease the level or effect of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Measure serum digoxin concentrations before initiating concomitant drugs; continue monitoring and increase digoxin dose by approximately 20% to 40% as necessary

• tepotinib

  tepotinib will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If concomitant use unavoidable, reduce the P-gp substrate dosage if recommended in its approved product labeling.

• timolol

  digoxin, timolol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

• trofinetide

  trofinetide will increase the level or effect of digoxin by Other (see comment). Avoid or Use Alternate Drug. Trofinetide (an OATP131 and OATP13B inhibitor) may increase plasma levels of OATP131 or OATP13B substrates. Avoid coadministration with sensitive substrates.

• vandetanib

  vandetanib increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

• venetoclax

  venetoclax will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. In vitro data suggest venetoclax may inhibit P-gp substrates at therapeutic dose levels in the gut. Avoid coadministration of narrow therapeutic index P-gp substrates with venetoclax. If a narrow therapeutic index P-gp substrate must be used, it should be taken at least 6 hr before venetoclax.

• verapamil

  verapamil increases levels of digoxin by decreasing renal clearance. Avoid or Use Alternate Drug.

Monitor Closely (303)

• abrocitinib

  abrocitinib will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor and titrate dose of P-gp substrate appropriately.

• acarbose

  acarbose will decrease the level or effect of digoxin by unspecified interaction mechanism. Use Caution/Monitor. Measure serum digoxin concentrations before initiating concomitant drugs; continue monitoring and increase digoxin dose by approximately 20% to 40% as necessary

• acebutolol

  acebutolol and digoxin both increase serum potassium. Use Caution/Monitor.
  
  acebutolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.

• aceclofenac

  aceclofenac and digoxin both increase serum potassium. Use Caution/Monitor.

• acemetacin

  acemetacin and digoxin both increase serum potassium. Use Caution/Monitor.

• activated charcoal

  activated charcoal decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

• albuterol

  digoxin increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• alprazolam

  alprazolam increases levels of digoxin by unknown mechanism. Use Caution/Monitor.

• amikacin

  amikacin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• amiloride

  amiloride and digoxin both increase serum potassium. Modify Therapy/Monitor Closely.

• anticholinergic/sedative combos

  anticholinergic/sedative combos increases levels of digoxin by unspecified interaction mechanism. Use Caution/Monitor.

• arformoterol

  digoxin increases and arformoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• aspirin

  aspirin and digoxin both increase serum potassium. Use Caution/Monitor.

• aspirin rectal

  aspirin rectal and digoxin both increase serum potassium. Use Caution/Monitor.

• aspirin/citric acid/sodium bicarbonate

  aspirin/citric acid/sodium bicarbonate and digoxin both increase serum potassium. Use Caution/Monitor.

• atazanavir

  atazanavir increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of AV block.

• atenolol

  atenolol and digoxin both increase serum potassium. Use Caution/Monitor.
  
  atenolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.

• atorvastatin

  atorvastatin will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• atropine

  atropine increases levels of digoxin by unknown mechanism. Use Caution/Monitor.

• atropine IV/IM

  atropine IV/IM increases levels of digoxin by unknown mechanism. Use Caution/Monitor.

• aztreonam

  aztreonam will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• benazepril

  benazepril increases levels of digoxin by unspecified interaction mechanism. Use Caution/Monitor.

• bendroflumethiazide

  digoxin increases and bendroflumethiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  bendroflumethiazide increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Hypokalemia increases digoxin effects.

• berotralstat

  berotralstat will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor or titrate P-gp substrate dose if coadministered.

• betaxolol

  betaxolol and digoxin both increase serum potassium. Use Caution/Monitor.
  
  betaxolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.

• bisoprolol

  bisoprolol and digoxin both increase serum potassium. Use Caution/Monitor.
  
  bisoprolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.

• bosutinib

  bosutinib increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• brimonidine

  brimonidine increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor.

• bumetanide

  digoxin increases and bumetanide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  bumetanide increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Hypokalemia increases digoxin effects.

• bupropion

  bupropion will decrease the level or effect of digoxin by Other (see comment). Use Caution/Monitor. Monitor for decreased digoxin concentrations; bupropion may induce OATP4C1 transporter, which is involved in digoxin renal elimination

• calcifediol

  calcifediol, digoxin. Other (see comment). Modify Therapy/Monitor Closely. Comment: Calcifediol may cause hypercalcemia which would increase the risk of digitalis toxicity. Monitor both serum calcium levels and for signs and symptoms of digitalis toxicity.

• calcium acetate

  calcium acetate increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor.

• calcium carbonate

  calcium carbonate increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor.

• calcium chloride

  calcium chloride increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor.

• calcium citrate

  calcium citrate increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor.

• calcium gluconate

  calcium gluconate increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor.

• canagliflozin

  canagliflozin increases levels of digoxin by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Digoxin AUC and peak serum concentration increased when coadministered with canagliflozin.

• candesartan

  candesartan and digoxin both increase serum potassium. Use Caution/Monitor.

• cannabidiol

  cannabidiol will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Therapeutic drug monitoring and dose reduction of P-gp substrates should be considered when given orally and concurrently with cannabidiol

• captopril

  captopril increases levels of digoxin by unspecified interaction mechanism. Use Caution/Monitor.

• carbenoxolone

  digoxin increases and carbenoxolone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• carmustine

  carmustine decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. It is prudent to closely monitor patients for loss of clinical efficacy of digoxin while receiving antineoplastic therapy.

• carvedilol

  carvedilol and digoxin both increase serum potassium. Use Caution/Monitor.
  
  carvedilol increases levels of digoxin by enhancing GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  carvedilol increases levels of digoxin by decreasing renal clearance. Use Caution/Monitor.
  
  carvedilol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.

• cefadroxil

  cefadroxil will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• cefamandole

  cefamandole will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• cefpirome

  cefpirome will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• cefpodoxime

  cefpodoxime will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• celecoxib

  celecoxib and digoxin both increase serum potassium. Use Caution/Monitor.

• celiprolol

  celiprolol and digoxin both increase serum potassium. Use Caution/Monitor.
  
  celiprolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.

• cephalexin

  cephalexin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• chlorhexidine oral

  chlorhexidine oral will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• chlorothiazide

  digoxin increases and chlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  chlorothiazide increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Hypokalemia increases digoxin effects.

• chlorthalidone

  digoxin increases and chlorthalidone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  chlorthalidone increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Hypokalemia increases digoxin effects.

• cholestyramine

  cholestyramine decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

• choline magnesium trisalicylate

  choline magnesium trisalicylate and digoxin both increase serum potassium. Use Caution/Monitor.

• clarithromycin

  clarithromycin will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• clindamycin

  clindamycin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• clotrimazole

  clotrimazole will decrease the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• cobicistat

  cobicistat will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Measure serum digoxin concentrations before initiating concomitant drugs. Titrate the digoxin dose by ~30-50% or by modifying the dosing frequency and continue monitoring.

• colestipol

  colestipol decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

• conivaptan

  conivaptan increases levels of digoxin by decreasing metabolism. Use Caution/Monitor.

• crizotinib

  crizotinib increases levels of digoxin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of crizotinib with CYP3A substrates with narrow therapeutic indices should be avoided.
  
  crizotinib increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• cyclopenthiazide

  digoxin increases and cyclopenthiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  cyclopenthiazide increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Hypokalemia increases digoxin effects.

• cyclophosphamide

  cyclophosphamide decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

• cyclosporine

  cyclosporine will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• cytarabine

  cytarabine decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Cytarabine may decrease digoxin absorption even several days after stopping chemotherapy. Digoxin capsules and digitoxin do not appear to be affected. .

• dapsone

  dapsone will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• darifenacin

  darifenacin increases levels of digoxin by unspecified interaction mechanism. Use Caution/Monitor.

• demeclocycline

  demeclocycline will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• dexlansoprazole

  dexlansoprazole increases toxicity of digoxin by Other (see comment). Use Caution/Monitor. Comment: Prolonged use of PPIs may cause hypomagnesemia and increase risk for digoxin toxicity.

• dichlorphenamide

  dichlorphenamide and digoxin both decrease serum potassium. Use Caution/Monitor.

• diclofenac

  diclofenac and digoxin both increase serum potassium. Use Caution/Monitor.

• diflunisal

  diflunisal and digoxin both increase serum potassium. Use Caution/Monitor.

• diphenoxylate hcl

  diphenoxylate hcl will increase the level or effect of digoxin by unspecified interaction mechanism. Use Caution/Monitor. Measure serum digoxin concentrations before initiating concomitant drugs; continue monitoring and reduce digoxin dose as necessary

• dobutamine

  digoxin increases and dobutamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dopamine

  dopamine increases toxicity of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Can increase risk of cardiac arrhythmias.

• dopexamine

  digoxin increases and dopexamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• doxorubicin

  doxorubicin decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

• doxorubicin liposomal

  doxorubicin liposomal decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

• doxycycline

  doxycycline will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• dronedarone

  dronedarone will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. If coadministered, consider reducing digoxin dose. Closely monitor serum digoxin levels and observe for digoxin toxicity.

• drospirenone

  drospirenone and digoxin both increase serum potassium. Modify Therapy/Monitor Closely.

• dulaglutide

  dulaglutide, digoxin. Other (see comment). Use Caution/Monitor. Comment: Dulaglutide slows gastric emptying and may impact absorption of concomitantly administered oral medications; be particularly cautious when coadministered with drugs that have a narrow therapeutic index.

• elacestrant

  elacestrant will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Reduce dose of P-gp substrates per their Prescribing Information when minimal concentration changes may lead to serious or life-threatening adverse reactions.

• elagolix

  elagolix will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• eliglustat

  eliglustat increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Measure digoxin levels before initiating eliglustat and reduce digoxin dose by 30%; continue to monitor digoxin levels and adjust dose accordingly.

• elvitegravir/cobicistat/emtricitabine/tenofovir DF

  elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Digoxin is a substrate for P-gp transport; cobicistat inhibits P-gp transport; initiate digoxin at low dose and carefully titrate.

• enalapril

  enalapril increases levels of digoxin by unspecified interaction mechanism. Use Caution/Monitor.

• encorafenib

  encorafenib will increase the level or effect of digoxin by Other (see comment). Modify Therapy/Monitor Closely. Encorafenib (a OATP1B1 and OATP1B3 inhibitor) may increase the concentration and toxicities of OATP1B1 and OATP1B3 substrates. Closely monitor for signs and symptoms of increased exposure and consider adjusting the dose of these substrates.

• ephedrine

  digoxin increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• epinephrine

  digoxin increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• epinephrine racemic

  digoxin increases and epinephrine racemic decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• epoprostenol

  epoprostenol will increase the level or effect of digoxin by unspecified interaction mechanism. Use Caution/Monitor. Measure serum digoxin concentrations before initiating concomitant drugs; continue monitoring and reduce digoxin dose as necessary

• eprosartan

  eprosartan and digoxin both increase serum potassium. Use Caution/Monitor.

• eribulin

  eribulin will decrease the level or effect of digoxin by Other (see comment). Use Caution/Monitor. Antineoplastic agents may decrease absorption of digoxin; monitor patients for therapeutic efficacy.

• ertapenem

  ertapenem will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• erythromycin base

  erythromycin base will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• erythromycin ethylsuccinate

  erythromycin ethylsuccinate will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• erythromycin lactobionate

  erythromycin lactobionate will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• erythromycin stearate

  erythromycin stearate will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• esmolol

  esmolol and digoxin both increase serum potassium. Use Caution/Monitor.
  
  esmolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.

• esomeprazole

  esomeprazole increases toxicity of digoxin by Other (see comment). Use Caution/Monitor. Comment: Prolonged use of PPIs may cause hypomagnesemia and increase risk for digoxin toxicity.

• ethacrynic acid

  digoxin increases and ethacrynic acid decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  ethacrynic acid increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Hypokalemia increases digoxin effects.

• etodolac

  etodolac and digoxin both increase serum potassium. Use Caution/Monitor.

• etravirine

  etravirine increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Potential for increased toxicity. .

• ezogabine

  ezogabine increases levels of digoxin by decreasing renal clearance. Use Caution/Monitor. Active metabolite, NAMR, may inhibit the renal tubular secretion. Monitor digoxin levels.

• famciclovir

  famciclovir increases levels of digoxin by unspecified interaction mechanism. Use Caution/Monitor. Coadministration increases digoxin Cmax by ~19%.

• felodipine

  felodipine will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• fenoprofen

  fenoprofen and digoxin both increase serum potassium. Use Caution/Monitor.

• ferric maltol

  ferric maltol, digoxin. Either increases levels of the other by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Coadministration of ferric maltol with certain oral medications may decrease the bioavailability of either ferric maltol and some oral drugs. For oral drugs where reductions in bioavailability may cause clinically significant effects on its safety or efficacy, separate administration of ferric maltol from these drugs. Duration of separation may depend on the absorption of the medication concomitantly administered (eg, time to peak concentration, whether the drug is an immediate or extended release product).

• fleroxacin

  fleroxacin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• flibanserin

  flibanserin increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Increase monitoring of concentrations of drugs transported by P-gp that have a narrow therapeutic index if coadministered with flibanserin.

• flurbiprofen

  flurbiprofen and digoxin both increase serum potassium. Use Caution/Monitor.

• formoterol

  digoxin increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• fosfomycin

  fosfomycin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• fosinopril

  fosinopril increases levels of digoxin by unspecified interaction mechanism. Use Caution/Monitor.

• fosphenytoin

  fosphenytoin will decrease the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• fostamatinib

  fostamatinib will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Concomitant use of fostamatinib may increase concentrations of P-gp substrates. Monitor for toxicities of the P-gp substrate drug that may require dosage reduction when given concurrently with fostamatinib.

• fostemsavir

  fostemsavir will increase the level or effect of digoxin by Other (see comment). Modify Therapy/Monitor Closely. Fostemsavir inhibits OATP1B1/3 transporter. If possible, avoid coadministration or modify dose of OATP1B1/3 substrates coadministered with fostemsavir.

• furosemide

  digoxin increases and furosemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  furosemide increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Hypokalemia increases digoxin effects.

• gemifloxacin

  gemifloxacin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• gentamicin

  gentamicin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.
  
  digoxin increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• glecaprevir/pibrentasvir

  glecaprevir/pibrentasvir will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Measure serum digoxin concentrations before initiating glecaprevir/pibrentasvir. To reduce digoxin concentrations, decrease the dose by ~50% or by modifying the dosing frequency and continue monitoring.

• glycopyrrolate

  glycopyrrolate increases levels of digoxin by unknown mechanism. Use Caution/Monitor.

• glycopyrrolate inhaled

  glycopyrrolate inhaled increases levels of digoxin by unknown mechanism. Use Caution/Monitor.

• hawthorn

  hawthorn increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor.

• hydrochlorothiazide

  digoxin will increase the level or effect of hydrochlorothiazide by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
  
  digoxin increases and hydrochlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  hydrochlorothiazide increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Hypokalemia increases digoxin effects.

• ibuprofen

  ibuprofen and digoxin both increase serum potassium. Use Caution/Monitor.

• ibuprofen IV

  ibuprofen IV and digoxin both increase serum potassium. Use Caution/Monitor.

• imidapril

  imidapril increases levels of digoxin by unspecified interaction mechanism. Use Caution/Monitor.

• indapamide

  digoxin increases and indapamide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  indapamide increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Hypokalemia increases digoxin effects.

• indinavir

  indinavir will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• indomethacin

  indomethacin and digoxin both increase serum potassium. Use Caution/Monitor.

• irbesartan

  irbesartan and digoxin both increase serum potassium. Use Caution/Monitor.

• isavuconazonium sulfate

  isavuconazonium sulfate will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• isoproterenol

  digoxin increases and isoproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• istradefylline

  istradefylline will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of P-gp substrates in clinical trials. Consider dose reduction of sensitive P-gp substrates.

• itraconazole

  itraconazole will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Measure digoxin levels before initiating concomitant drugs. Monitor and consider reducing the digoxin dose by ~30-50% or modifying the dosing frequency.

• ivabradine

  ivabradine, digoxin. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Most patients receiving ivabradine will also be treated with a beta-blocker. The risk of bradycardia increases with coadministration of drugs that slow heart rate (eg, digoxin, amiodarone, beta-blockers). Monitor heart rate in patients taking ivabradine with other negative chronotropes.

• ivacaftor

  ivacaftor increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Ivacaftor and its M1 metabolite has the potential to inhibit P-gp; may significantly increase systemic exposure to sensitive P-gp substrates with a narrow therapeutic index.

• ketoconazole

  ketoconazole will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• ketoprofen

  ketoprofen and digoxin both increase serum potassium. Use Caution/Monitor.

• ketorolac

  ketorolac and digoxin both increase serum potassium. Use Caution/Monitor.

• ketorolac intranasal

  ketorolac intranasal and digoxin both increase serum potassium. Use Caution/Monitor.

• labetalol

  labetalol and digoxin both increase serum potassium. Use Caution/Monitor.
  
  labetalol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.

• lansoprazole

  lansoprazole increases toxicity of digoxin by Other (see comment). Use Caution/Monitor. Comment: Prolonged use of PPIs may cause hypomagnesemia and increase risk for digoxin toxicity.

• lapatinib

  lapatinib will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• ledipasvir/sofosbuvir

  ledipasvir/sofosbuvir will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely.

• lenacapavir

  lenacapavir will increase the level or effect of digoxin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Use with caution and monitor digoxin therapeutic concentration.

• levalbuterol

  digoxin increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• levofloxacin

  levofloxacin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• levoketoconazole

  levoketoconazole will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• levothyroxine

  levothyroxine decreases effects of digoxin by unknown mechanism. Use Caution/Monitor.

• linezolid

  linezolid will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• liothyronine

  liothyronine decreases effects of digoxin by unknown mechanism. Use Caution/Monitor.

• lisinopril

  lisinopril increases levels of digoxin by unspecified interaction mechanism. Use Caution/Monitor.

• lomitapide

  lomitapide increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Consider reducing dose when used concomitantly with lomitapide.

• lonafarnib

  lonafarnib will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Lonafarnib is a weak P-gp inhibitor. Monitor for adverse reactions if coadministered with P-gp substrates where minimal concentration changes may lead to serious or life-threatening toxicities. Reduce P-gp substrate dose if needed.

• loratadine

  loratadine will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• lornoxicam

  lornoxicam and digoxin both increase serum potassium. Use Caution/Monitor.

• losartan

  losartan and digoxin both increase serum potassium. Use Caution/Monitor.

• lumacaftor/ivacaftor

  lumacaftor/ivacaftor, digoxin. P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Lumacaftor has the potential to both inhibit and induce P-gp. Additionally, a clinical study with ivacaftor monotherapy showed that ivacaftor is a weak inhibitor of P-gp.

• meclofenamate

  meclofenamate and digoxin both increase serum potassium. Use Caution/Monitor.

• mefenamic acid

  mefenamic acid and digoxin both increase serum potassium. Use Caution/Monitor.

• meloxicam

  meloxicam and digoxin both increase serum potassium. Use Caution/Monitor.

• memantine

  digoxin will increase the level or effect of memantine by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.

• meropenem

  meropenem will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• meropenem/vaborbactam

  meropenem/vaborbactam will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• metaproterenol

  digoxin increases and metaproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• metformin

  digoxin, metformin. Either increases levels of the other by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor. Measure serum digoxin concentrations before initiating metformin. Monitor patients who take both metformin and digoxin for possible digoxin toxicity and lactic acidosis. Reduce the digoxin and/or metformin dose as necessary.

• methotrexate

  methotrexate decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Serum levels of digoxin may be reduced and actions may be decreased. Monitor patient for signs of reduction in pharmacologic effect of digoxin and increase digoxin dose if necessary. Serum level monitoring may facilitate tailoring dosage.

• methyclothiazide

  digoxin will increase the level or effect of methyclothiazide by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
  
  digoxin increases and methyclothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
  
  methyclothiazide increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Hypokalemia increases digoxin effects.

• metipranolol ophthalmic

  metipranolol ophthalmic increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor.

• metoclopramide

  metoclopramide decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

• metoclopramide intranasal

  metoclopramide intranasal will increase the level or effect of digoxin by Other (see comment). Use Caution/Monitor. Metoclopramide may decrease the absorption of digoxin. Monitor therapeutic drug concentrations and increase the digoxin dose as needed.

• metolazone

  digoxin increases and metolazone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  metolazone increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Hypokalemia increases digoxin effects.

• metoprolol

  metoprolol and digoxin both increase serum potassium. Use Caution/Monitor.
  
  metoprolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.

• metronidazole

  metronidazole will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• midodrine

  digoxin will increase the level or effect of midodrine by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.

• mineral oil

  mineral oil decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

• minocycline

  minocycline will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• mirabegron

  mirabegron will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• moexipril

  moexipril increases levels of digoxin by unspecified interaction mechanism. Use Caution/Monitor.

• moxifloxacin

  moxifloxacin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• nabumetone

  nabumetone and digoxin both increase serum potassium. Use Caution/Monitor.

• nadolol

  nadolol and digoxin both increase serum potassium. Use Caution/Monitor.
  
  nadolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.

• nafcillin

  nafcillin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• naproxen

  naproxen and digoxin both increase serum potassium. Use Caution/Monitor.

• nebivolol

  nebivolol and digoxin both increase serum potassium. Use Caution/Monitor.
  
  nebivolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.

• nefazodone

  nefazodone will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• neomycin PO

  neomycin PO will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.
  
  neomycin PO decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

• neratinib

  neratinib increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Neratinib inhibits P-gp transport. Caution if coadministered with a P-gp substrate with a narrow therapeutic index.

• nicardipine

  nicardipine will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• nifedipine

  nifedipine will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Nifedipine may decrease digoxin clearance, increasing plasma concentrations and the risk of toxicity. Adjust the digoxin dose as needed.

• nilotinib

  nilotinib will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• nirmatrelvir

  nirmatrelvir will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Measure serum digoxin concentrations before initiating nirmatrelvir/ritonavir. Decrease digoxin dose by ~30-50% or by modifying dosing frequency and continue monitoring during coadministration.

• nirmatrelvir/ritonavir

  nirmatrelvir/ritonavir will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Measure serum digoxin concentrations before initiating nirmatrelvir/ritonavir. Decrease digoxin dose by ~30-50% or by modifying dosing frequency and continue monitoring during coadministration.

• nitrofurantoin

  nitrofurantoin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• norepinephrine

  digoxin increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ofloxacin

  ofloxacin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.
  
  digoxin will increase the level or effect of ofloxacin by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.

• olmesartan

  olmesartan and digoxin both increase serum potassium. Use Caution/Monitor.

• omeprazole

  omeprazole increases toxicity of digoxin by Other (see comment). Use Caution/Monitor. Comment: Prolonged use of PPIs may cause hypomagnesemia and increase risk for digoxin toxicity.

• oxaprozin

  oxaprozin and digoxin both increase serum potassium. Use Caution/Monitor.

• oxymetazoline topical

  oxymetazoline topical decreases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Digoxin reduces catecholamine reuptake at nerve terminals, rendering blood vessels more sensitive to endogenous or exogenous catecholamines.

• oxytetracycline

  oxytetracycline will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• pantoprazole

  pantoprazole increases toxicity of digoxin by Other (see comment). Use Caution/Monitor. Comment: Prolonged use of PPIs may cause hypomagnesemia and increase risk for digoxin toxicity.

• parecoxib

  parecoxib and digoxin both increase serum potassium. Use Caution/Monitor.

• paricalcitol

  paricalcitol increases toxicity of digoxin by pharmacodynamic synergism. Use Caution/Monitor.

• paromomycin

  paromomycin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• penbutolol

  penbutolol and digoxin both increase serum potassium. Use Caution/Monitor.
  
  penbutolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.

• perindopril

  perindopril increases levels of digoxin by unspecified interaction mechanism. Use Caution/Monitor.

• phenobarbital

  phenobarbital will decrease the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• phenytoin

  phenytoin will decrease the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• pindolol

  pindolol and digoxin both increase serum potassium. Use Caution/Monitor.
  
  pindolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.

• pirbuterol

  digoxin increases and pirbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• piroxicam

  piroxicam and digoxin both increase serum potassium. Use Caution/Monitor.

• pirtobrutinib

  pirtobrutinib will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Pirtobrutinib (a P-gp inhibitor) may increase plasma concentrations of sensitive P-gp substrates, which may increase the risk of adverse reactions related to these substrates.

• pivmecillinam

  pivmecillinam will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• ponatinib

  ponatinib increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• posaconazole

  posaconazole increases levels of digoxin by decreasing metabolism. Use Caution/Monitor.

• potassium acid phosphate

  potassium acid phosphate and digoxin both increase serum potassium. Modify Therapy/Monitor Closely.

• potassium chloride

  potassium chloride and digoxin both increase serum potassium. Modify Therapy/Monitor Closely.

• pramipexole

  digoxin will increase the level or effect of pramipexole by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.

• pretomanid

  pretomanid will increase the level or effect of digoxin by Other (see comment). Use Caution/Monitor. Increase monitoring for drug-related adverse effects if pretomanid is coadministered with sensitive OATP1B3 or P-gp substrates.

• procarbazine

  procarbazine decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

• propantheline

  propantheline will increase the level or effect of digoxin by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Measure serum digoxin concentrations before initiating concomitant drugs; reduce digoxin dose by approximately 15% to 30% or by modifying dosing frequency and continue monitoring

• propranolol

  propranolol and digoxin both increase serum potassium. Use Caution/Monitor.
  
  propranolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.

• quercetin

  quercetin will decrease the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• quinapril

  quinapril increases levels of digoxin by unspecified interaction mechanism. Use Caution/Monitor.

• quinine

  digoxin will increase the level or effect of quinine by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.

• quinupristin/dalfopristin

  quinupristin/dalfopristin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• rabeprazole

  rabeprazole increases toxicity of digoxin by Other (see comment). Use Caution/Monitor. Comment: Prolonged use of PPIs may cause hypomagnesemia and increase risk for digoxin toxicity.

• ramipril

  ramipril increases levels of digoxin by unspecified interaction mechanism. Use Caution/Monitor.

• ranolazine

  ranolazine will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  ranolazine increases levels of digoxin by decreasing metabolism. Use Caution/Monitor. Ranolazine inhibits P glycoprotein.

• regorafenib

  regorafenib will decrease the level or effect of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Chemotherapy may decrease absorption of digoxin; monitor levels and adjust digoxin dose accordingly

• rifabutin

  rifabutin decreases levels of digoxin by increasing metabolism. Use Caution/Monitor.

• rifampin

  rifampin will decrease the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Reduced digoxin serum concentrations, possibly with a suboptimal therapeutic response, may be seen.
  
  rifampin decreases levels of digoxin by increasing metabolism. Use Caution/Monitor.

• rifapentine

  rifapentine decreases levels of digoxin by increasing metabolism. Use Caution/Monitor.

• ritonavir

  ritonavir will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Plasma concentrations and pharmacologic effects of digoxin may be increased by ritonavir. Monitor for increased effects of digoxin.
  
  ritonavir increases levels of digoxin by decreasing renal clearance. Use Caution/Monitor.
  
  ritonavir increases levels of digoxin by decreasing hepatic clearance. Use Caution/Monitor.

• rolapitant

  rolapitant will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Oral rolapitant (P-gp inhibitor) may increase plasma concentrations of P-gp substrates and may result in potential adverse reactions. Monitor digoxin concentrations with concomitant rolapitant use and adjust dosage if necessary.

• sacubitril/valsartan

  sacubitril/valsartan and digoxin both increase serum potassium. Use Caution/Monitor.

• salicylates (non-asa)

  salicylates (non-asa) and digoxin both increase serum potassium. Use Caution/Monitor.

• salmeterol

  digoxin increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• salsalate

  salsalate and digoxin both increase serum potassium. Use Caution/Monitor.

• saquinavir

  saquinavir increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Potential for increased toxicity. .

• sarecycline

  sarecycline will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor for toxicities of P-gp substrates that may require dosage reduction when coadministered with P-gp inhibitors.

• senna

  senna increases toxicity of digoxin by Other (see comment). Use Caution/Monitor. Comment: Increased risk of cardiac toxicity due to K+ depletion.

• sevelamer

  sevelamer decreases levels of digoxin by increasing elimination. Use Caution/Monitor.

• simvastatin

  simvastatin will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• sirolimus

  sirolimus will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• sodium picosulfate/magnesium oxide/anhydrous citric acid

  sodium picosulfate/magnesium oxide/anhydrous citric acid decreases levels of digoxin by cation binding in GI tract. Use Caution/Monitor. Take at least 2 hours before and not less than 6 hours after administration of sodium picosulfate, magnesium oxide and anhydrous citric acid to avoid magnesium chelation .

• sodium sulfate/?magnesium sulfate/potassium chloride

  sodium sulfate/?magnesium sulfate/potassium chloride decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Administer digoxin at least 2 hr before and no less than 6 hr after each dose to avoid chelation with magnesium. .

• sodium sulfate/potassium sulfate/magnesium sulfate

  sodium sulfate/potassium sulfate/magnesium sulfate decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Administer digoxin at least 2 hr before and no less than 6 hr after each dose to avoid chelation with magnesium. .

• sofosbuvir/velpatasvir

  sofosbuvir/velpatasvir will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Velpatasvir inhibits P-gp. Monitor digoxin levels if coadministered. Refer to digoxin prescribing information for monitoring and dose modification recommendations for digoxin concentration increases of <50%.

• sotagliflozin

  sotagliflozin will increase the level or effect of digoxin by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Increased exposure of digoxin when coadministered with sotagliflozin 400 mg

• sotalol

  sotalol and digoxin both increase serum potassium. Use Caution/Monitor.
  
  sotalol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.

• spironolactone

  spironolactone and digoxin both increase serum potassium. Modify Therapy/Monitor Closely.
  
  spironolactone, digoxin. Mechanism: decreasing renal clearance. Use Caution/Monitor. False digoxin assay results may be obtained.
  
  spironolactone increases levels of digoxin by Other (see comment). Use Caution/Monitor. Comment: Spironolactone may cause false elevation of digoxin assay.

• St John's Wort

  St John's Wort will decrease the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  St John's Wort decreases levels of digoxin by increasing metabolism. Use Caution/Monitor.

• stiripentol

  stiripentol will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Consider reducing the dose of P-glycoprotein (P-gp) substrates, if adverse reactions are experienced when administered concomitantly with stiripentol.

• streptomycin

  streptomycin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• succinylcholine

  digoxin and succinylcholine both increase serum potassium. Use Caution/Monitor.
  
  succinylcholine, digoxin. Mechanism: unknown. Use Caution/Monitor. Increased risk of cardiac arrhythmias.

• sulfadiazine

  sulfadiazine will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• sulfamethoxazole

  sulfamethoxazole will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.
  
  sulfamethoxazole will increase the level or effect of digoxin by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.

• sulfasalazine

  sulfasalazine and digoxin both increase serum potassium. Use Caution/Monitor.
  
  sulfasalazine decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Sulfasalazine >2 g/day.

• sulfisoxazole

  sulfisoxazole will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• sulindac

  sulindac and digoxin both increase serum potassium. Use Caution/Monitor.

• suvorexant

  suvorexant will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Suvorexant may cause a slight increase in digoxin levels

• tacrolimus

  tacrolimus will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• teduglutide

  teduglutide increases levels of digoxin by Other (see comment). Use Caution/Monitor. Comment: Teduglutide may increase absorption of concomitant PO medications; caution with with drugs requiring titration or those with a narrow therapeutic index; dose adjustment may be necessary.

• teicoplanin

  teicoplanin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• telmisartan

  telmisartan and digoxin both increase serum potassium. Use Caution/Monitor.
  
  telmisartan increases levels of digoxin by unknown mechanism. Use Caution/Monitor.

• temocillin

  temocillin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• tenofovir DF

  tenofovir DF increases levels of digoxin by decreasing renal clearance. Use Caution/Monitor. Potential for increased toxicity. .

• terbutaline

  digoxin increases and terbutaline decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• teriparatide

  teriparatide increases toxicity of digoxin by Other (see comment). Use Caution/Monitor. Comment: Transient hypercalcemia may predispose to digoxin toxicity (rare case reports).

• tetracycline

  tetracycline will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• thyroid desiccated

  thyroid desiccated decreases effects of digoxin by unknown mechanism. Use Caution/Monitor.

• ticagrelor

  ticagrelor increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Ticagrelor inhibits P-glycoprotein transporter. Monitor digoxin levels with initiation of or any change in ticagrelor therapy.

• ticarcillin

  ticarcillin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• tigecycline

  tigecycline will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• timolol

  timolol and digoxin both increase serum potassium. Use Caution/Monitor.
  
  timolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.

• tipranavir

  tipranavir increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Potential for increased toxicity. .

• tobramycin

  tobramycin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• tolfenamic acid

  tolfenamic acid and digoxin both increase serum potassium. Use Caution/Monitor.

• tolmetin

  tolmetin and digoxin both increase serum potassium. Use Caution/Monitor.

• tolvaptan

  tolvaptan will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  digoxin and tolvaptan both increase serum potassium. Use Caution/Monitor.

• torsemide

  digoxin increases and torsemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  torsemide increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Hypokalemia increases digoxin effects.

• trandolapril

  trandolapril increases levels of digoxin by unspecified interaction mechanism. Use Caution/Monitor.

• trazodone

  trazodone will decrease the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  trazodone increases levels of digoxin by unspecified interaction mechanism. Use Caution/Monitor.

• triamterene

  digoxin will increase the level or effect of triamterene by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
  
  triamterene and digoxin both increase serum potassium. Modify Therapy/Monitor Closely.

• trimagnesium citrate anhydrous

  digoxin decreases effects of trimagnesium citrate anhydrous by increasing renal clearance. Use Caution/Monitor.

• trimethoprim

  trimethoprim will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.
  
  digoxin will increase the level or effect of trimethoprim by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.

• trospium chloride

  digoxin, trospium chloride. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

• tucatinib

  tucatinib will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Consider reducing the dosage of P-gp substrates, where minimal concentration changes may lead to serious or life-threatening toxicities.

• ulipristal

  ulipristal increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• ustekinumab

  ustekinumab, digoxin. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, normalizing the formation of CYP450 enzymes. Upon initiation or discontinuation of ustekinumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

• valsartan

  valsartan will increase the level or effect of digoxin by decreasing renal clearance. Use Caution/Monitor. Monitor digoxin levels closely when coadministered with drugs that may decrease glomerular filtration or tubular secretion.

• vancomycin

  vancomycin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• vemurafenib

  vemurafenib increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• verapamil

  verapamil will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Toxicity characterized by gastrointestinal and neuropsychiatric symptoms, and cardiac arrhythmias may result.
  
  digoxin will increase the level or effect of verapamil by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.

• vincristine

  vincristine decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

• vincristine liposomal

  vincristine liposomal decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

• vitamin D

  vitamin D increases toxicity of digoxin by Other (see comment). Use Caution/Monitor. Comment: Vitamin D may cause hypercalcemia which may affect the actions of digoxin and/or lead to cardiac arrhythmias.

Minor (38)

• albiglutide

  albiglutide decreases levels of digoxin by unspecified interaction mechanism. Minor/Significance Unknown.

• cimetidine

  cimetidine will increase the level or effect of digoxin by increasing gastric pH. Applies only to oral form of both agents. Minor/Significance Unknown.
  
  cimetidine will increase the level or effect of digoxin by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• ciprofloxacin

  ciprofloxacin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

• exenatide injectable solution

  exenatide injectable solution decreases levels of digoxin by unspecified interaction mechanism. Minor/Significance Unknown.

• exenatide injectable suspension

  exenatide injectable suspension decreases levels of digoxin by unspecified interaction mechanism. Minor/Significance Unknown.

• flavoxate

  flavoxate increases effects of digoxin by unspecified interaction mechanism. Minor/Significance Unknown.

• ibuprofen

  ibuprofen increases levels of digoxin by decreasing renal clearance. Minor/Significance Unknown.

• ibuprofen IV

  ibuprofen IV increases levels of digoxin by decreasing renal clearance. Minor/Significance Unknown.

• ifosfamide

  ifosfamide will decrease the level or effect of digoxin by Other (see comment). Minor/Significance Unknown. Antineoplastic agents that cause significant mucositis/stomatitis may be more likely to impair digoxin tablet absorption

• inamrinone

  inamrinone, digoxin. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown.

• indomethacin

  indomethacin increases levels of digoxin by decreasing renal clearance. Minor/Significance Unknown.

• licorice

  licorice increases effects of digoxin by pharmacodynamic synergism. Minor/Significance Unknown.

• liraglutide

  liraglutide decreases levels of digoxin by unspecified interaction mechanism. Minor/Significance Unknown.

• lomustine

  lomustine will decrease the level or effect of digoxin by Other (see comment). Minor/Significance Unknown. Antineoplastic agents that cause significant mucositis/stomatitis may be more likely to impair digoxin tablet absorption

• magnesium chloride

  digoxin decreases levels of magnesium chloride by increasing renal clearance. Minor/Significance Unknown.

• magnesium citrate

  digoxin decreases levels of magnesium citrate by increasing renal clearance. Minor/Significance Unknown.

• magnesium hydroxide

  digoxin decreases levels of magnesium hydroxide by increasing renal clearance. Minor/Significance Unknown.

• magnesium oxide

  digoxin decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• magnesium sulfate

  digoxin decreases levels of magnesium sulfate by increasing renal clearance. Minor/Significance Unknown.

• mechlorethamine

  mechlorethamine will decrease the level or effect of digoxin by Other (see comment). Minor/Significance Unknown. Antineoplastic agents that cause significant mucositis/stomatitis may be more likely to impair digoxin tablet absorption

• meclizine

  meclizine increases levels of digoxin by unspecified interaction mechanism. Minor/Significance Unknown.

• melphalan

  melphalan will decrease the level or effect of digoxin by Other (see comment). Minor/Significance Unknown. Antineoplastic agents that cause significant mucositis/stomatitis may be more likely to impair digoxin tablet absorption

• miglitol

  miglitol decreases levels of digoxin by unspecified interaction mechanism. Minor/Significance Unknown.

• nefazodone

  nefazodone increases levels of digoxin by unknown mechanism. Minor/Significance Unknown.

• nitrendipine

  nitrendipine increases levels of digoxin by decreasing elimination. Minor/Significance Unknown.

• noni juice

  digoxin and noni juice both increase serum potassium. Minor/Significance Unknown.

• oxybutynin

  oxybutynin increases levels of digoxin by unspecified interaction mechanism. Minor/Significance Unknown.

• oxybutynin topical

  oxybutynin topical increases levels of digoxin by unspecified interaction mechanism. Minor/Significance Unknown.

• oxybutynin transdermal

  oxybutynin transdermal increases levels of digoxin by unspecified interaction mechanism. Minor/Significance Unknown.

• penicillamine

  penicillamine decreases levels of digoxin by unknown mechanism. Minor/Significance Unknown.

• pentagastrin

  pentagastrin decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• pleurisy root

  pleurisy root, digoxin. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Theoretical interaction, due to cardenolide glycoside content of pleurisy root.

• shepherd's purse

  shepherd's purse, digoxin. Other (see comment). Minor/Significance Unknown. Comment: Theoretically, shepherd's purse may interfere with cardiovascular therapy.

• Siberian ginseng

  Siberian ginseng increases levels of digoxin by unknown mechanism. Minor/Significance Unknown.

• sitagliptin

  sitagliptin increases levels of digoxin by unspecified interaction mechanism. Minor/Significance Unknown.

• tigecycline

  tigecycline decreases levels of digoxin by unspecified interaction mechanism. Minor/Significance Unknown.

• topiramate

  topiramate decreases levels of digoxin by unspecified interaction mechanism. Minor/Significance Unknown.

• vanadium

  vanadium increases effects of digoxin by pharmacodynamic synergism. Minor/Significance Unknown.

• abrocitinib

  Monitor Closely (1)abrocitinib will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor and titrate dose of P-gp substrate appropriately.

• acarbose

  Monitor Closely (1)acarbose will decrease the level or effect of digoxin by unspecified interaction mechanism. Use Caution/Monitor. Measure serum digoxin concentrations before initiating concomitant drugs; continue monitoring and increase digoxin dose by approximately 20% to 40% as necessary

• acebutolol

  Monitor Closely (2)acebutolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.
  
  acebutolol and digoxin both increase serum potassium. Use Caution/Monitor.

• aceclofenac

  Monitor Closely (1)aceclofenac and digoxin both increase serum potassium. Use Caution/Monitor.

• acemetacin

  Monitor Closely (1)acemetacin and digoxin both increase serum potassium. Use Caution/Monitor.

• activated charcoal

  Monitor Closely (1)activated charcoal decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

• adagrasib

  Serious - Use Alternative (1)adagrasib will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Avoid coadministration of adagrasib, a P-gp inhibitor, with sensitive P-gp substrates unless otherwise recommended in the prescribing information for these substrates.

• albiglutide

  Minor (1)albiglutide decreases levels of digoxin by unspecified interaction mechanism. Minor/Significance Unknown.

• albuterol

  Monitor Closely (1)digoxin increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• alprazolam

  Monitor Closely (1)alprazolam increases levels of digoxin by unknown mechanism. Use Caution/Monitor.

• aluminum hydroxide

  Serious - Use Alternative (1)aluminum hydroxide will increase the level or effect of digoxin by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• amikacin

  Monitor Closely (1)amikacin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• amiloride

  Monitor Closely (1)amiloride and digoxin both increase serum potassium. Modify Therapy/Monitor Closely.

• amiodarone

  Serious - Use Alternative (2)amiodarone will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Amiodarone increases PO digoxin serum concentrations by ~70% and IV digoxin by ~17%; measure digoxin levels before initiating amiodarone and reduce PO digoxin dose by 30-50%; decrease IV digoxin dose by 15-30%
  
  amiodarone will increase the level or effect of digoxin by basic (cationic) drug competition for renal tubular clearance. Avoid or Use Alternate Drug. Amiodarone increases PO digoxin serum concentrations by ~70% and IV digoxin by ~17%; measure digoxin levels before initiating amiodarone and reduce PO digoxin dose by 30-50%; decrease IV digoxin dose by 15-30%

• amphotericin B deoxycholate

  Serious - Use Alternative (1)amphotericin B deoxycholate increases effects of digoxin by pharmacodynamic synergism. Avoid or Use Alternate Drug. Digoxin effects increased if hypokalemia results from Ampho B Tx.

• anticholinergic/sedative combos

  Monitor Closely (1)anticholinergic/sedative combos increases levels of digoxin by unspecified interaction mechanism. Use Caution/Monitor.

• arformoterol

  Monitor Closely (1)digoxin increases and arformoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• aspirin

  Monitor Closely (1)aspirin and digoxin both increase serum potassium. Use Caution/Monitor.

• aspirin rectal

  Monitor Closely (1)aspirin rectal and digoxin both increase serum potassium. Use Caution/Monitor.

• aspirin/citric acid/sodium bicarbonate

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate and digoxin both increase serum potassium. Use Caution/Monitor.

• atazanavir

  Monitor Closely (1)atazanavir increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of AV block.

• atenolol

  Monitor Closely (2)atenolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.
  
  atenolol and digoxin both increase serum potassium. Use Caution/Monitor.Serious - Use Alternative (1)digoxin, atenolol. Either decreases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

• atorvastatin

  Monitor Closely (1)atorvastatin will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• atropine

  Monitor Closely (1)atropine increases levels of digoxin by unknown mechanism. Use Caution/Monitor.

• atropine IV/IM

  Monitor Closely (1)atropine IV/IM increases levels of digoxin by unknown mechanism. Use Caution/Monitor.

• azithromycin

  Serious - Use Alternative (1)azithromycin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• aztreonam

  Monitor Closely (1)aztreonam will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• benazepril

  Monitor Closely (1)benazepril increases levels of digoxin by unspecified interaction mechanism. Use Caution/Monitor.

• bendroflumethiazide

  Monitor Closely (2)bendroflumethiazide increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Hypokalemia increases digoxin effects.
  
  digoxin increases and bendroflumethiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• berotralstat

  Monitor Closely (1)berotralstat will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor or titrate P-gp substrate dose if coadministered.

• betaxolol

  Monitor Closely (2)betaxolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.
  
  betaxolol and digoxin both increase serum potassium. Use Caution/Monitor.Serious - Use Alternative (1)digoxin, betaxolol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

• bisoprolol

  Monitor Closely (2)bisoprolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.
  
  bisoprolol and digoxin both increase serum potassium. Use Caution/Monitor.Serious - Use Alternative (1)digoxin, bisoprolol. Either decreases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

• bosutinib

  Monitor Closely (1)bosutinib increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• bremelanotide

  Serious - Use Alternative (1)bremelanotide will decrease the level or effect of digoxin by Other (see comment). Avoid or Use Alternate Drug. Bremelanotide may slow gastric emptying and potentially reduces the rate and extent of absorption of concomitantly administered oral medications. Avoid use when taking any oral drug that is dependent on threshold concentrations for efficacy. Interactions listed are representative examples and do not include all possible clinical examples.

• bretylium

  Serious - Use Alternative (1)bretylium increases toxicity of digoxin by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Avoid simultaneous initiation of therapy with digitalis glycosides and bretylium. Initial release of norepinephrine caused by bretylium may aggravate digitalis toxicity. When a life-threatening cardiac arrhythmia occurs in a digitalized patient, bretylium should be used only if the etiology of the arrhythmia does not appear to be digitalis toxicity and other antiarrhythmic drugs are not effective. Bretylium is contraindicated for digitalis-induced arrhythmias.

• brimonidine

  Monitor Closely (1)brimonidine increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor.

• bumetanide

  Monitor Closely (2)bumetanide increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Hypokalemia increases digoxin effects.
  
  digoxin increases and bumetanide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• bupropion

  Monitor Closely (1)bupropion will decrease the level or effect of digoxin by Other (see comment). Use Caution/Monitor. Monitor for decreased digoxin concentrations; bupropion may induce OATP4C1 transporter, which is involved in digoxin renal elimination

• calcifediol

  Monitor Closely (1)calcifediol, digoxin. Other (see comment). Modify Therapy/Monitor Closely. Comment: Calcifediol may cause hypercalcemia which would increase the risk of digitalis toxicity. Monitor both serum calcium levels and for signs and symptoms of digitalis toxicity.

• calcium acetate

  Monitor Closely (1)calcium acetate increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor.

• calcium carbonate

  Monitor Closely (1)calcium carbonate increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor.Serious - Use Alternative (1)calcium carbonate will increase the level or effect of digoxin by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• calcium chloride

  Monitor Closely (1)calcium chloride increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor.

• calcium citrate

  Monitor Closely (1)calcium citrate increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor.

• calcium gluconate

  Monitor Closely (1)calcium gluconate increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor.

• canagliflozin

  Monitor Closely (1)canagliflozin increases levels of digoxin by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Digoxin AUC and peak serum concentration increased when coadministered with canagliflozin.

• candesartan

  Monitor Closely (1)candesartan and digoxin both increase serum potassium. Use Caution/Monitor.

• cannabidiol

  Monitor Closely (1)cannabidiol will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Therapeutic drug monitoring and dose reduction of P-gp substrates should be considered when given orally and concurrently with cannabidiol

• captopril

  Monitor Closely (1)captopril increases levels of digoxin by unspecified interaction mechanism. Use Caution/Monitor.

• carbenoxolone

  Monitor Closely (1)digoxin increases and carbenoxolone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• carmustine

  Monitor Closely (1)carmustine decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. It is prudent to closely monitor patients for loss of clinical efficacy of digoxin while receiving antineoplastic therapy.

• carvedilol

  Monitor Closely (4)carvedilol increases levels of digoxin by enhancing GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  carvedilol increases levels of digoxin by decreasing renal clearance. Use Caution/Monitor.
  
  carvedilol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.
  
  carvedilol and digoxin both increase serum potassium. Use Caution/Monitor.

• cefadroxil

  Monitor Closely (1)cefadroxil will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• cefamandole

  Monitor Closely (1)cefamandole will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• cefpirome

  Monitor Closely (1)cefpirome will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• cefpodoxime

  Monitor Closely (1)cefpodoxime will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• celecoxib

  Monitor Closely (1)celecoxib and digoxin both increase serum potassium. Use Caution/Monitor.

• celiprolol

  Monitor Closely (2)celiprolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.
  
  celiprolol and digoxin both increase serum potassium. Use Caution/Monitor.

• cephalexin

  Monitor Closely (1)cephalexin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• chlorhexidine oral

  Monitor Closely (1)chlorhexidine oral will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• chlorothiazide

  Monitor Closely (2)chlorothiazide increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Hypokalemia increases digoxin effects.
  
  digoxin increases and chlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• chlorthalidone

  Monitor Closely (2)chlorthalidone increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Hypokalemia increases digoxin effects.
  
  digoxin increases and chlorthalidone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• cholestyramine

  Monitor Closely (1)cholestyramine decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

• choline magnesium trisalicylate

  Monitor Closely (1)choline magnesium trisalicylate and digoxin both increase serum potassium. Use Caution/Monitor.

• cimetidine

  Minor (2)cimetidine will increase the level or effect of digoxin by increasing gastric pH. Applies only to oral form of both agents. Minor/Significance Unknown.
  
  cimetidine will increase the level or effect of digoxin by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• ciprofloxacin

  Minor (1)ciprofloxacin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

• clarithromycin

  Monitor Closely (1)clarithromycin will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (1)clarithromycin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• clindamycin

  Monitor Closely (1)clindamycin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• clotrimazole

  Monitor Closely (1)clotrimazole will decrease the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• cobicistat

  Monitor Closely (1)cobicistat will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Measure serum digoxin concentrations before initiating concomitant drugs. Titrate the digoxin dose by ~30-50% or by modifying the dosing frequency and continue monitoring.

• colchicine

  Serious - Use Alternative (1)colchicine, digoxin. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Increased risk of rhabdomyolysis.

• colestipol

  Monitor Closely (1)colestipol decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

• conivaptan

  Monitor Closely (1)conivaptan increases levels of digoxin by decreasing metabolism. Use Caution/Monitor.

• crizotinib

  Monitor Closely (2)crizotinib increases levels of digoxin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of crizotinib with CYP3A substrates with narrow therapeutic indices should be avoided.
  
  crizotinib increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• cyclopenthiazide

  Monitor Closely (2)cyclopenthiazide increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Hypokalemia increases digoxin effects.
  
  digoxin increases and cyclopenthiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• cyclophosphamide

  Monitor Closely (1)cyclophosphamide decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

• cyclosporine

  Monitor Closely (1)cyclosporine will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (1)cyclosporine increases levels of digoxin by decreasing renal clearance. Avoid or Use Alternate Drug.

• cytarabine

  Monitor Closely (1)cytarabine decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Cytarabine may decrease digoxin absorption even several days after stopping chemotherapy. Digoxin capsules and digitoxin do not appear to be affected. .

• dapsone

  Monitor Closely (1)dapsone will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• darifenacin

  Monitor Closely (1)darifenacin increases levels of digoxin by unspecified interaction mechanism. Use Caution/Monitor.

• demeclocycline

  Monitor Closely (1)demeclocycline will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• dexlansoprazole

  Monitor Closely (1)dexlansoprazole increases toxicity of digoxin by Other (see comment). Use Caution/Monitor. Comment: Prolonged use of PPIs may cause hypomagnesemia and increase risk for digoxin toxicity.Serious - Use Alternative (1)dexlansoprazole will increase the level or effect of digoxin by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• dichlorphenamide

  Monitor Closely (1)dichlorphenamide and digoxin both decrease serum potassium. Use Caution/Monitor.

• diclofenac

  Monitor Closely (1)diclofenac and digoxin both increase serum potassium. Use Caution/Monitor.

• diflunisal

  Monitor Closely (1)diflunisal and digoxin both increase serum potassium. Use Caution/Monitor.

• diphenoxylate hcl

  Monitor Closely (1)diphenoxylate hcl will increase the level or effect of digoxin by unspecified interaction mechanism. Use Caution/Monitor. Measure serum digoxin concentrations before initiating concomitant drugs; continue monitoring and reduce digoxin dose as necessary

• dobutamine

  Monitor Closely (1)digoxin increases and dobutamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dofetilide

  Serious - Use Alternative (1)digoxin will increase the level or effect of dofetilide by basic (cationic) drug competition for renal tubular clearance. Avoid or Use Alternate Drug.

• dopamine

  Monitor Closely (1)dopamine increases toxicity of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Can increase risk of cardiac arrhythmias.

• dopexamine

  Monitor Closely (1)digoxin increases and dopexamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• doxorubicin

  Monitor Closely (1)doxorubicin decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

• doxorubicin liposomal

  Monitor Closely (1)doxorubicin liposomal decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

• doxycycline

  Monitor Closely (1)doxycycline will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• dronedarone

  Monitor Closely (1)dronedarone will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. If coadministered, consider reducing digoxin dose. Closely monitor serum digoxin levels and observe for digoxin toxicity.

• drospirenone

  Monitor Closely (1)drospirenone and digoxin both increase serum potassium. Modify Therapy/Monitor Closely.

• dulaglutide

  Monitor Closely (1)dulaglutide, digoxin. Other (see comment). Use Caution/Monitor. Comment: Dulaglutide slows gastric emptying and may impact absorption of concomitantly administered oral medications; be particularly cautious when coadministered with drugs that have a narrow therapeutic index.

• elacestrant

  Monitor Closely (1)elacestrant will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Reduce dose of P-gp substrates per their Prescribing Information when minimal concentration changes may lead to serious or life-threatening adverse reactions.

• elagolix

  Monitor Closely (1)elagolix will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• eliglustat

  Monitor Closely (1)eliglustat increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Measure digoxin levels before initiating eliglustat and reduce digoxin dose by 30%; continue to monitor digoxin levels and adjust dose accordingly.

• eluxadoline

  Serious - Use Alternative (1)digoxin increases levels of eluxadoline by decreasing metabolism. Avoid or Use Alternate Drug. Decrease eluxadoline dose to 75 mg PO BID if coadministered with OATP1B1 inhibitors. .

• elvitegravir/cobicistat/emtricitabine/tenofovir DF

  Monitor Closely (1)elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Digoxin is a substrate for P-gp transport; cobicistat inhibits P-gp transport; initiate digoxin at low dose and carefully titrate.

• enalapril

  Monitor Closely (1)enalapril increases levels of digoxin by unspecified interaction mechanism. Use Caution/Monitor.

• encorafenib

  Monitor Closely (1)encorafenib will increase the level or effect of digoxin by Other (see comment). Modify Therapy/Monitor Closely. Encorafenib (a OATP1B1 and OATP1B3 inhibitor) may increase the concentration and toxicities of OATP1B1 and OATP1B3 substrates. Closely monitor for signs and symptoms of increased exposure and consider adjusting the dose of these substrates.

• ephedrine

  Monitor Closely (1)digoxin increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• epinephrine

  Monitor Closely (1)digoxin increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• epinephrine racemic

  Monitor Closely (1)digoxin increases and epinephrine racemic decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• epoprostenol

  Monitor Closely (1)epoprostenol will increase the level or effect of digoxin by unspecified interaction mechanism. Use Caution/Monitor. Measure serum digoxin concentrations before initiating concomitant drugs; continue monitoring and reduce digoxin dose as necessary

• eprosartan

  Monitor Closely (1)eprosartan and digoxin both increase serum potassium. Use Caution/Monitor.

• erdafitinib

  Serious - Use Alternative (1)erdafitinib will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If coadministration unavoidable, separate administration by at least 6 hr before or after administration of P-gp substrates with narrow therapeutic index.

• eribulin

  Monitor Closely (1)eribulin will decrease the level or effect of digoxin by Other (see comment). Use Caution/Monitor. Antineoplastic agents may decrease absorption of digoxin; monitor patients for therapeutic efficacy.

• ertapenem

  Monitor Closely (1)ertapenem will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• erythromycin base

  Monitor Closely (1)erythromycin base will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (1)erythromycin base will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• erythromycin ethylsuccinate

  Monitor Closely (1)erythromycin ethylsuccinate will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (1)erythromycin ethylsuccinate will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• erythromycin lactobionate

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• erythromycin stearate

  Monitor Closely (1)erythromycin stearate will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (1)erythromycin stearate will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• esmolol

  Monitor Closely (2)esmolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.
  
  esmolol and digoxin both increase serum potassium. Use Caution/Monitor.Serious - Use Alternative (1)digoxin, esmolol. Either decreases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

• esomeprazole

  Monitor Closely (1)esomeprazole increases toxicity of digoxin by Other (see comment). Use Caution/Monitor. Comment: Prolonged use of PPIs may cause hypomagnesemia and increase risk for digoxin toxicity.Serious - Use Alternative (1)esomeprazole will increase the level or effect of digoxin by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• ethacrynic acid

  Monitor Closely (2)ethacrynic acid increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Hypokalemia increases digoxin effects.
  
  digoxin increases and ethacrynic acid decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• etodolac

  Monitor Closely (1)etodolac and digoxin both increase serum potassium. Use Caution/Monitor.

• etravirine

  Monitor Closely (1)etravirine increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Potential for increased toxicity. .

• exenatide injectable solution

  Minor (1)exenatide injectable solution decreases levels of digoxin by unspecified interaction mechanism. Minor/Significance Unknown.

• exenatide injectable suspension

  Minor (1)exenatide injectable suspension decreases levels of digoxin by unspecified interaction mechanism. Minor/Significance Unknown.

• ezogabine

  Monitor Closely (1)ezogabine increases levels of digoxin by decreasing renal clearance. Use Caution/Monitor. Active metabolite, NAMR, may inhibit the renal tubular secretion. Monitor digoxin levels.

• famciclovir

  Monitor Closely (1)famciclovir increases levels of digoxin by unspecified interaction mechanism. Use Caution/Monitor. Coadministration increases digoxin Cmax by ~19%.

• famotidine

  Serious - Use Alternative (1)famotidine will increase the level or effect of digoxin by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• felodipine

  Monitor Closely (1)felodipine will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• fenoprofen

  Monitor Closely (1)fenoprofen and digoxin both increase serum potassium. Use Caution/Monitor.

• ferric maltol

  Monitor Closely (1)ferric maltol, digoxin. Either increases levels of the other by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Coadministration of ferric maltol with certain oral medications may decrease the bioavailability of either ferric maltol and some oral drugs. For oral drugs where reductions in bioavailability may cause clinically significant effects on its safety or efficacy, separate administration of ferric maltol from these drugs. Duration of separation may depend on the absorption of the medication concomitantly administered (eg, time to peak concentration, whether the drug is an immediate or extended release product).

• flavoxate

  Minor (1)flavoxate increases effects of digoxin by unspecified interaction mechanism. Minor/Significance Unknown.

• flecainide

  Serious - Use Alternative (1)flecainide increases effects of digoxin by unknown mechanism. Avoid or Use Alternate Drug.

• fleroxacin

  Monitor Closely (1)fleroxacin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• flibanserin

  Monitor Closely (1)flibanserin increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Increase monitoring of concentrations of drugs transported by P-gp that have a narrow therapeutic index if coadministered with flibanserin.

• flurbiprofen

  Monitor Closely (1)flurbiprofen and digoxin both increase serum potassium. Use Caution/Monitor.

• formoterol

  Monitor Closely (1)digoxin increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• fosfomycin

  Monitor Closely (1)fosfomycin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• fosinopril

  Monitor Closely (1)fosinopril increases levels of digoxin by unspecified interaction mechanism. Use Caution/Monitor.

• fosphenytoin

  Monitor Closely (1)fosphenytoin will decrease the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• fostamatinib

  Monitor Closely (1)fostamatinib will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Concomitant use of fostamatinib may increase concentrations of P-gp substrates. Monitor for toxicities of the P-gp substrate drug that may require dosage reduction when given concurrently with fostamatinib.

• fostemsavir

  Monitor Closely (1)fostemsavir will increase the level or effect of digoxin by Other (see comment). Modify Therapy/Monitor Closely. Fostemsavir inhibits OATP1B1/3 transporter. If possible, avoid coadministration or modify dose of OATP1B1/3 substrates coadministered with fostemsavir.

• furosemide

  Monitor Closely (2)furosemide increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Hypokalemia increases digoxin effects.
  
  digoxin increases and furosemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• gemifloxacin

  Monitor Closely (1)gemifloxacin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• gentamicin

  Monitor Closely (2)gentamicin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.
  
  digoxin increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• glecaprevir/pibrentasvir

  Monitor Closely (1)glecaprevir/pibrentasvir will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Measure serum digoxin concentrations before initiating glecaprevir/pibrentasvir. To reduce digoxin concentrations, decrease the dose by ~50% or by modifying the dosing frequency and continue monitoring.

• glycopyrrolate

  Monitor Closely (1)glycopyrrolate increases levels of digoxin by unknown mechanism. Use Caution/Monitor.

• glycopyrrolate inhaled

  Monitor Closely (1)glycopyrrolate inhaled increases levels of digoxin by unknown mechanism. Use Caution/Monitor.

• hawthorn

  Monitor Closely (1)hawthorn increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor.

• human parathyroid hormone, recombinant

  Serious - Use Alternative (1)human parathyroid hormone, recombinant, digoxin. Other (see comment). Avoid or Use Alternate Drug. Comment: rhPTH causes transient increase in calcium and therefore, concomitant use with cardiac glycosides may predispose patients to digitalis toxicity if hypercalcemia develops. Digoxin efficacy is reduced if hypocalcemia is present. If coadministered, carefully monitor serum calcium and digoxin levels, and patients for signs and symptoms of digoxin toxicity. Adjustment of digoxin and/or rhPTH dose may be needed.

• hydrochlorothiazide

  Monitor Closely (3)digoxin will increase the level or effect of hydrochlorothiazide by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
  
  hydrochlorothiazide increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Hypokalemia increases digoxin effects.
  
  digoxin increases and hydrochlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• hydroxychloroquine sulfate

  Serious - Use Alternative (1)hydroxychloroquine sulfate increases levels of digoxin by unknown mechanism. Avoid or Use Alternate Drug.

• ibuprofen

  Monitor Closely (1)ibuprofen and digoxin both increase serum potassium. Use Caution/Monitor.Minor (1)ibuprofen increases levels of digoxin by decreasing renal clearance. Minor/Significance Unknown.

• ibuprofen IV

  Monitor Closely (1)ibuprofen IV and digoxin both increase serum potassium. Use Caution/Monitor.Minor (1)ibuprofen IV increases levels of digoxin by decreasing renal clearance. Minor/Significance Unknown.

• ibuprofen/famotidine

  Serious - Use Alternative (1)ibuprofen/famotidine will increase the level or effect of digoxin by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• ifosfamide

  Minor (1)ifosfamide will decrease the level or effect of digoxin by Other (see comment). Minor/Significance Unknown. Antineoplastic agents that cause significant mucositis/stomatitis may be more likely to impair digoxin tablet absorption

• imidapril

  Monitor Closely (1)imidapril increases levels of digoxin by unspecified interaction mechanism. Use Caution/Monitor.

• inamrinone

  Minor (1)inamrinone, digoxin. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown.

• indapamide

  Monitor Closely (2)indapamide increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Hypokalemia increases digoxin effects.
  
  digoxin increases and indapamide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• indinavir

  Monitor Closely (1)indinavir will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• indomethacin

  Monitor Closely (1)indomethacin and digoxin both increase serum potassium. Use Caution/Monitor.Minor (1)indomethacin increases levels of digoxin by decreasing renal clearance. Minor/Significance Unknown.

• irbesartan

  Monitor Closely (1)irbesartan and digoxin both increase serum potassium. Use Caution/Monitor.

• isavuconazonium sulfate

  Monitor Closely (1)isavuconazonium sulfate will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• isoproterenol

  Monitor Closely (1)digoxin increases and isoproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• istradefylline

  Monitor Closely (1)istradefylline will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of P-gp substrates in clinical trials. Consider dose reduction of sensitive P-gp substrates.

• itraconazole

  Monitor Closely (1)itraconazole will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Measure digoxin levels before initiating concomitant drugs. Monitor and consider reducing the digoxin dose by ~30-50% or modifying the dosing frequency.

• ivabradine

  Monitor Closely (1)ivabradine, digoxin. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Most patients receiving ivabradine will also be treated with a beta-blocker. The risk of bradycardia increases with coadministration of drugs that slow heart rate (eg, digoxin, amiodarone, beta-blockers). Monitor heart rate in patients taking ivabradine with other negative chronotropes.

• ivacaftor

  Monitor Closely (1)ivacaftor increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Ivacaftor and its M1 metabolite has the potential to inhibit P-gp; may significantly increase systemic exposure to sensitive P-gp substrates with a narrow therapeutic index.

• ketoconazole

  Monitor Closely (1)ketoconazole will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• ketoprofen

  Monitor Closely (1)ketoprofen and digoxin both increase serum potassium. Use Caution/Monitor.

• ketorolac

  Monitor Closely (1)ketorolac and digoxin both increase serum potassium. Use Caution/Monitor.

• ketorolac intranasal

  Monitor Closely (1)ketorolac intranasal and digoxin both increase serum potassium. Use Caution/Monitor.

• labetalol

  Monitor Closely (2)labetalol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.
  
  labetalol and digoxin both increase serum potassium. Use Caution/Monitor.

• lansoprazole

  Monitor Closely (1)lansoprazole increases toxicity of digoxin by Other (see comment). Use Caution/Monitor. Comment: Prolonged use of PPIs may cause hypomagnesemia and increase risk for digoxin toxicity.Serious - Use Alternative (1)lansoprazole will increase the level or effect of digoxin by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• lapatinib

  Monitor Closely (1)lapatinib will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• lasmiditan

  Serious - Use Alternative (1)lasmiditan increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

• ledipasvir/sofosbuvir

  Monitor Closely (1)ledipasvir/sofosbuvir will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely.

• lenacapavir

  Monitor Closely (1)lenacapavir will increase the level or effect of digoxin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Use with caution and monitor digoxin therapeutic concentration.

• leniolisib

  Serious - Use Alternative (1)leniolisib will increase the level or effect of digoxin by Other (see comment). Avoid or Use Alternate Drug. Leniolisib, an OATP1B1 and OATP1B3 inhibitor, may increase systemic exposure of these substrates

• levalbuterol

  Monitor Closely (1)digoxin increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• levobunolol

  Serious - Use Alternative (1)digoxin, levobunolol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

• levofloxacin

  Monitor Closely (1)levofloxacin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• levoketoconazole

  Monitor Closely (1)levoketoconazole will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• levothyroxine

  Monitor Closely (1)levothyroxine decreases effects of digoxin by unknown mechanism. Use Caution/Monitor.

• licorice

  Minor (1)licorice increases effects of digoxin by pharmacodynamic synergism. Minor/Significance Unknown.

• lily of the valley

  Serious - Use Alternative (1)digoxin, lily of the valley. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.

• linezolid

  Monitor Closely (1)linezolid will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• liothyronine

  Monitor Closely (1)liothyronine decreases effects of digoxin by unknown mechanism. Use Caution/Monitor.

• liraglutide

  Minor (1)liraglutide decreases levels of digoxin by unspecified interaction mechanism. Minor/Significance Unknown.

• lisinopril

  Monitor Closely (1)lisinopril increases levels of digoxin by unspecified interaction mechanism. Use Caution/Monitor.

• lomitapide

  Monitor Closely (1)lomitapide increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Consider reducing dose when used concomitantly with lomitapide.

• lomustine

  Minor (1)lomustine will decrease the level or effect of digoxin by Other (see comment). Minor/Significance Unknown. Antineoplastic agents that cause significant mucositis/stomatitis may be more likely to impair digoxin tablet absorption

• lonafarnib

  Monitor Closely (1)lonafarnib will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Lonafarnib is a weak P-gp inhibitor. Monitor for adverse reactions if coadministered with P-gp substrates where minimal concentration changes may lead to serious or life-threatening toxicities. Reduce P-gp substrate dose if needed.

• loratadine

  Monitor Closely (1)loratadine will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• lornoxicam

  Monitor Closely (1)lornoxicam and digoxin both increase serum potassium. Use Caution/Monitor.

• losartan

  Monitor Closely (1)losartan and digoxin both increase serum potassium. Use Caution/Monitor.

• lumacaftor/ivacaftor

  Monitor Closely (1)lumacaftor/ivacaftor, digoxin. P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Lumacaftor has the potential to both inhibit and induce P-gp. Additionally, a clinical study with ivacaftor monotherapy showed that ivacaftor is a weak inhibitor of P-gp.

• magnesium chloride

  Minor (1)digoxin decreases levels of magnesium chloride by increasing renal clearance. Minor/Significance Unknown.

• magnesium citrate

  Minor (1)digoxin decreases levels of magnesium citrate by increasing renal clearance. Minor/Significance Unknown.

• magnesium hydroxide

  Minor (1)digoxin decreases levels of magnesium hydroxide by increasing renal clearance. Minor/Significance Unknown.

• magnesium oxide

  Minor (1)digoxin decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

• magnesium sulfate

  Minor (1)digoxin decreases levels of magnesium sulfate by increasing renal clearance. Minor/Significance Unknown.

• mechlorethamine

  Minor (1)mechlorethamine will decrease the level or effect of digoxin by Other (see comment). Minor/Significance Unknown. Antineoplastic agents that cause significant mucositis/stomatitis may be more likely to impair digoxin tablet absorption

• meclizine

  Minor (1)meclizine increases levels of digoxin by unspecified interaction mechanism. Minor/Significance Unknown.

• meclofenamate

  Monitor Closely (1)meclofenamate and digoxin both increase serum potassium. Use Caution/Monitor.

• mefenamic acid

  Monitor Closely (1)mefenamic acid and digoxin both increase serum potassium. Use Caution/Monitor.

• meloxicam

  Monitor Closely (1)meloxicam and digoxin both increase serum potassium. Use Caution/Monitor.

• melphalan

  Minor (1)melphalan will decrease the level or effect of digoxin by Other (see comment). Minor/Significance Unknown. Antineoplastic agents that cause significant mucositis/stomatitis may be more likely to impair digoxin tablet absorption

• memantine

  Monitor Closely (1)digoxin will increase the level or effect of memantine by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.

• meropenem

  Monitor Closely (1)meropenem will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• meropenem/vaborbactam

  Monitor Closely (1)meropenem/vaborbactam will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• metaproterenol

  Monitor Closely (1)digoxin increases and metaproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• metformin

  Monitor Closely (1)digoxin, metformin. Either increases levels of the other by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor. Measure serum digoxin concentrations before initiating metformin. Monitor patients who take both metformin and digoxin for possible digoxin toxicity and lactic acidosis. Reduce the digoxin and/or metformin dose as necessary.

• methotrexate

  Monitor Closely (1)methotrexate decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Serum levels of digoxin may be reduced and actions may be decreased. Monitor patient for signs of reduction in pharmacologic effect of digoxin and increase digoxin dose if necessary. Serum level monitoring may facilitate tailoring dosage.

• methyclothiazide

  Monitor Closely (3)digoxin will increase the level or effect of methyclothiazide by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
  
  methyclothiazide increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Hypokalemia increases digoxin effects.
  
  digoxin increases and methyclothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

• metipranolol ophthalmic

  Monitor Closely (1)metipranolol ophthalmic increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor.

• metoclopramide

  Monitor Closely (1)metoclopramide decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

• metoclopramide intranasal

  Monitor Closely (1)metoclopramide intranasal will increase the level or effect of digoxin by Other (see comment). Use Caution/Monitor. Metoclopramide may decrease the absorption of digoxin. Monitor therapeutic drug concentrations and increase the digoxin dose as needed.

• metolazone

  Monitor Closely (2)metolazone increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Hypokalemia increases digoxin effects.
  
  digoxin increases and metolazone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• metoprolol

  Monitor Closely (2)metoprolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.
  
  metoprolol and digoxin both increase serum potassium. Use Caution/Monitor.Serious - Use Alternative (1)digoxin increases toxicity of metoprolol by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

• metronidazole

  Monitor Closely (1)metronidazole will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• midodrine

  Monitor Closely (1)digoxin will increase the level or effect of midodrine by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.

• miglitol

  Minor (1)miglitol decreases levels of digoxin by unspecified interaction mechanism. Minor/Significance Unknown.

• mineral oil

  Monitor Closely (1)mineral oil decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

• minocycline

  Monitor Closely (1)minocycline will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• mirabegron

  Monitor Closely (1)mirabegron will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• moexipril

  Monitor Closely (1)moexipril increases levels of digoxin by unspecified interaction mechanism. Use Caution/Monitor.

• moxifloxacin

  Monitor Closely (1)moxifloxacin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• nabumetone

  Monitor Closely (1)nabumetone and digoxin both increase serum potassium. Use Caution/Monitor.

• nadolol

  Monitor Closely (2)nadolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.
  
  nadolol and digoxin both increase serum potassium. Use Caution/Monitor.Serious - Use Alternative (1)digoxin, nadolol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

• nafcillin

  Monitor Closely (1)nafcillin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• naproxen

  Monitor Closely (1)naproxen and digoxin both increase serum potassium. Use Caution/Monitor.

• nebivolol

  Monitor Closely (2)nebivolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.
  
  nebivolol and digoxin both increase serum potassium. Use Caution/Monitor.Serious - Use Alternative (1)digoxin, nebivolol. Either decreases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

• nefazodone

  Monitor Closely (1)nefazodone will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Minor (1)nefazodone increases levels of digoxin by unknown mechanism. Minor/Significance Unknown.

• neomycin PO

  Monitor Closely (2)neomycin PO will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.
  
  neomycin PO decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

• neratinib

  Monitor Closely (1)neratinib increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Neratinib inhibits P-gp transport. Caution if coadministered with a P-gp substrate with a narrow therapeutic index.

• nicardipine

  Monitor Closely (1)nicardipine will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• nifedipine

  Monitor Closely (1)nifedipine will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Nifedipine may decrease digoxin clearance, increasing plasma concentrations and the risk of toxicity. Adjust the digoxin dose as needed.

• nilotinib

  Monitor Closely (1)nilotinib will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• nirmatrelvir

  Monitor Closely (1)nirmatrelvir will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Measure serum digoxin concentrations before initiating nirmatrelvir/ritonavir. Decrease digoxin dose by ~30-50% or by modifying dosing frequency and continue monitoring during coadministration.

• nirmatrelvir/ritonavir

  Monitor Closely (1)nirmatrelvir/ritonavir will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Measure serum digoxin concentrations before initiating nirmatrelvir/ritonavir. Decrease digoxin dose by ~30-50% or by modifying dosing frequency and continue monitoring during coadministration.

• nitrendipine

  Minor (1)nitrendipine increases levels of digoxin by decreasing elimination. Minor/Significance Unknown.

• nitrofurantoin

  Monitor Closely (1)nitrofurantoin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• nizatidine

  Serious - Use Alternative (1)nizatidine will increase the level or effect of digoxin by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• noni juice

  Minor (1)digoxin and noni juice both increase serum potassium. Minor/Significance Unknown.

• norepinephrine

  Monitor Closely (1)digoxin increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ofloxacin

  Monitor Closely (2)ofloxacin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.
  
  digoxin will increase the level or effect of ofloxacin by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.

• olmesartan

  Monitor Closely (1)olmesartan and digoxin both increase serum potassium. Use Caution/Monitor.

• omeprazole

  Monitor Closely (1)omeprazole increases toxicity of digoxin by Other (see comment). Use Caution/Monitor. Comment: Prolonged use of PPIs may cause hypomagnesemia and increase risk for digoxin toxicity.Serious - Use Alternative (1)omeprazole will increase the level or effect of digoxin by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• oxaprozin

  Monitor Closely (1)oxaprozin and digoxin both increase serum potassium. Use Caution/Monitor.

• oxybutynin

  Minor (1)oxybutynin increases levels of digoxin by unspecified interaction mechanism. Minor/Significance Unknown.

• oxybutynin topical

  Minor (1)oxybutynin topical increases levels of digoxin by unspecified interaction mechanism. Minor/Significance Unknown.

• oxybutynin transdermal

  Minor (1)oxybutynin transdermal increases levels of digoxin by unspecified interaction mechanism. Minor/Significance Unknown.

• oxymetazoline topical

  Monitor Closely (1)oxymetazoline topical decreases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Digoxin reduces catecholamine reuptake at nerve terminals, rendering blood vessels more sensitive to endogenous or exogenous catecholamines.

• oxytetracycline

  Monitor Closely (1)oxytetracycline will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• ozanimod

  Serious - Use Alternative (1)ozanimod increases toxicity of digoxin by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.

• pacritinib

  Serious - Use Alternative (1)pacritinib will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

• pantoprazole

  Monitor Closely (1)pantoprazole increases toxicity of digoxin by Other (see comment). Use Caution/Monitor. Comment: Prolonged use of PPIs may cause hypomagnesemia and increase risk for digoxin toxicity.Serious - Use Alternative (1)pantoprazole will increase the level or effect of digoxin by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• parecoxib

  Monitor Closely (1)parecoxib and digoxin both increase serum potassium. Use Caution/Monitor.

• paricalcitol

  Monitor Closely (1)paricalcitol increases toxicity of digoxin by pharmacodynamic synergism. Use Caution/Monitor.

• paromomycin

  Monitor Closely (1)paromomycin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• penbutolol

  Monitor Closely (2)penbutolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.
  
  penbutolol and digoxin both increase serum potassium. Use Caution/Monitor.

• penicillamine

  Minor (1)penicillamine decreases levels of digoxin by unknown mechanism. Minor/Significance Unknown.

• pentagastrin

  Minor (1)pentagastrin decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• perindopril

  Monitor Closely (1)perindopril increases levels of digoxin by unspecified interaction mechanism. Use Caution/Monitor.

• phenobarbital

  Monitor Closely (1)phenobarbital will decrease the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• phenytoin

  Monitor Closely (1)phenytoin will decrease the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• pindolol

  Monitor Closely (2)pindolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.
  
  pindolol and digoxin both increase serum potassium. Use Caution/Monitor.

• pirbuterol

  Monitor Closely (1)digoxin increases and pirbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• piroxicam

  Monitor Closely (1)piroxicam and digoxin both increase serum potassium. Use Caution/Monitor.

• pirtobrutinib

  Monitor Closely (1)pirtobrutinib will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Pirtobrutinib (a P-gp inhibitor) may increase plasma concentrations of sensitive P-gp substrates, which may increase the risk of adverse reactions related to these substrates.

• pivmecillinam

  Monitor Closely (1)pivmecillinam will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• pleurisy root

  Minor (1)pleurisy root, digoxin. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Theoretical interaction, due to cardenolide glycoside content of pleurisy root.

• ponatinib

  Monitor Closely (1)ponatinib increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• ponesimod

  Serious - Use Alternative (1)ponesimod, digoxin. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

• posaconazole

  Monitor Closely (1)posaconazole increases levels of digoxin by decreasing metabolism. Use Caution/Monitor.

• potassium acid phosphate

  Monitor Closely (1)potassium acid phosphate and digoxin both increase serum potassium. Modify Therapy/Monitor Closely.

• potassium chloride

  Monitor Closely (1)potassium chloride and digoxin both increase serum potassium. Modify Therapy/Monitor Closely.

• pramipexole

  Monitor Closely (1)digoxin will increase the level or effect of pramipexole by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.

• pretomanid

  Monitor Closely (1)pretomanid will increase the level or effect of digoxin by Other (see comment). Use Caution/Monitor. Increase monitoring for drug-related adverse effects if pretomanid is coadministered with sensitive OATP1B3 or P-gp substrates.

• procainamide

  Serious - Use Alternative (1)digoxin will increase the level or effect of procainamide by basic (cationic) drug competition for renal tubular clearance. Avoid or Use Alternate Drug.

• procarbazine

  Monitor Closely (1)procarbazine decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

• propafenone

  Serious - Use Alternative (1)propafenone increases levels of digoxin by decreasing renal clearance. Avoid or Use Alternate Drug.

• propantheline

  Monitor Closely (1)propantheline will increase the level or effect of digoxin by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Measure serum digoxin concentrations before initiating concomitant drugs; reduce digoxin dose by approximately 15% to 30% or by modifying dosing frequency and continue monitoring

• propranolol

  Monitor Closely (2)propranolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.
  
  propranolol and digoxin both increase serum potassium. Use Caution/Monitor.Serious - Use Alternative (1)digoxin, propranolol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

• quercetin

  Monitor Closely (1)quercetin will decrease the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• quinapril

  Monitor Closely (1)quinapril increases levels of digoxin by unspecified interaction mechanism. Use Caution/Monitor.

• quinidine

  Serious - Use Alternative (2)quinidine will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.
  
  quinidine will increase the level or effect of digoxin by basic (cationic) drug competition for renal tubular clearance. Avoid or Use Alternate Drug.

• quinine

  Monitor Closely (1)digoxin will increase the level or effect of quinine by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.

• quinupristin/dalfopristin

  Monitor Closely (1)quinupristin/dalfopristin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• rabeprazole

  Monitor Closely (1)rabeprazole increases toxicity of digoxin by Other (see comment). Use Caution/Monitor. Comment: Prolonged use of PPIs may cause hypomagnesemia and increase risk for digoxin toxicity.Serious - Use Alternative (1)rabeprazole will increase the level or effect of digoxin by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• ramipril

  Monitor Closely (1)ramipril increases levels of digoxin by unspecified interaction mechanism. Use Caution/Monitor.

• ranolazine

  Monitor Closely (2)ranolazine will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  ranolazine increases levels of digoxin by decreasing metabolism. Use Caution/Monitor. Ranolazine inhibits P glycoprotein.

• regorafenib

  Monitor Closely (1)regorafenib will decrease the level or effect of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Chemotherapy may decrease absorption of digoxin; monitor levels and adjust digoxin dose accordingly

• rifabutin

  Monitor Closely (1)rifabutin decreases levels of digoxin by increasing metabolism. Use Caution/Monitor.

• rifampin

  Monitor Closely (2)rifampin will decrease the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Reduced digoxin serum concentrations, possibly with a suboptimal therapeutic response, may be seen.
  
  rifampin decreases levels of digoxin by increasing metabolism. Use Caution/Monitor.

• rifapentine

  Monitor Closely (1)rifapentine decreases levels of digoxin by increasing metabolism. Use Caution/Monitor.

• ritonavir

  Monitor Closely (3)ritonavir will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Plasma concentrations and pharmacologic effects of digoxin may be increased by ritonavir. Monitor for increased effects of digoxin.
  
  ritonavir increases levels of digoxin by decreasing renal clearance. Use Caution/Monitor.
  
  ritonavir increases levels of digoxin by decreasing hepatic clearance. Use Caution/Monitor.

• rolapitant

  Monitor Closely (1)rolapitant will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Oral rolapitant (P-gp inhibitor) may increase plasma concentrations of P-gp substrates and may result in potential adverse reactions. Monitor digoxin concentrations with concomitant rolapitant use and adjust dosage if necessary.

• roxithromycin

  Serious - Use Alternative (1)roxithromycin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• sacubitril/valsartan

  Monitor Closely (1)sacubitril/valsartan and digoxin both increase serum potassium. Use Caution/Monitor.

• salicylates (non-asa)

  Monitor Closely (1)salicylates (non-asa) and digoxin both increase serum potassium. Use Caution/Monitor.

• salmeterol

  Monitor Closely (1)digoxin increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• salsalate

  Monitor Closely (1)salsalate and digoxin both increase serum potassium. Use Caution/Monitor.

• saquinavir

  Monitor Closely (1)saquinavir increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Potential for increased toxicity. .

• sarecycline

  Monitor Closely (1)sarecycline will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor for toxicities of P-gp substrates that may require dosage reduction when coadministered with P-gp inhibitors.

• senna

  Monitor Closely (1)senna increases toxicity of digoxin by Other (see comment). Use Caution/Monitor. Comment: Increased risk of cardiac toxicity due to K+ depletion.

• sevelamer

  Monitor Closely (1)sevelamer decreases levels of digoxin by increasing elimination. Use Caution/Monitor.

• shepherd's purse

  Minor (1)shepherd's purse, digoxin. Other (see comment). Minor/Significance Unknown. Comment: Theoretically, shepherd's purse may interfere with cardiovascular therapy.

• Siberian ginseng

  Minor (1)Siberian ginseng increases levels of digoxin by unknown mechanism. Minor/Significance Unknown.

• simvastatin

  Monitor Closely (1)simvastatin will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• siponimod

  Serious - Use Alternative (1)siponimod, digoxin. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Because of the potential additive effects on heart rate, siponimod should generally not be initiated in patients taking QT prolonging drugs with known arrhythmogenic properties, heart rate lowering calcium channel blockers, or other drugs that may decrease heart rate. If treatment considered, obtain cardiology consult regarding switching to non-heart-rate lowering drugs or appropriate monitoring for treatment initiation.

• sirolimus

  Monitor Closely (1)sirolimus will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• sitagliptin

  Minor (1)sitagliptin increases levels of digoxin by unspecified interaction mechanism. Minor/Significance Unknown.

• sodium bicarbonate

  Serious - Use Alternative (1)sodium bicarbonate will increase the level or effect of digoxin by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• sodium citrate/citric acid

  Serious - Use Alternative (1)sodium citrate/citric acid will increase the level or effect of digoxin by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• sodium picosulfate/magnesium oxide/anhydrous citric acid

  Monitor Closely (1)sodium picosulfate/magnesium oxide/anhydrous citric acid decreases levels of digoxin by cation binding in GI tract. Use Caution/Monitor. Take at least 2 hours before and not less than 6 hours after administration of sodium picosulfate, magnesium oxide and anhydrous citric acid to avoid magnesium chelation .

• sodium sulfate/?magnesium sulfate/potassium chloride

  Monitor Closely (1)sodium sulfate/?magnesium sulfate/potassium chloride decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Administer digoxin at least 2 hr before and no less than 6 hr after each dose to avoid chelation with magnesium. .

• sodium sulfate/potassium sulfate/magnesium sulfate

  Monitor Closely (1)sodium sulfate/potassium sulfate/magnesium sulfate decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Administer digoxin at least 2 hr before and no less than 6 hr after each dose to avoid chelation with magnesium. .

• sofosbuvir/velpatasvir

  Monitor Closely (1)sofosbuvir/velpatasvir will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Velpatasvir inhibits P-gp. Monitor digoxin levels if coadministered. Refer to digoxin prescribing information for monitoring and dose modification recommendations for digoxin concentration increases of <50%.

• sotagliflozin

  Monitor Closely (1)sotagliflozin will increase the level or effect of digoxin by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Increased exposure of digoxin when coadministered with sotagliflozin 400 mg

• sotalol

  Monitor Closely (2)sotalol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.
  
  sotalol and digoxin both increase serum potassium. Use Caution/Monitor.Serious - Use Alternative (1)digoxin, sotalol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

• sotorasib

  Serious - Use Alternative (1)sotorasib will decrease the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If use is unavoidable, refer to the prescribing information of the P-gp substrate for dosage modifications.

• spironolactone

  Monitor Closely (3)spironolactone, digoxin. Mechanism: decreasing renal clearance. Use Caution/Monitor. False digoxin assay results may be obtained.
  
  spironolactone increases levels of digoxin by Other (see comment). Use Caution/Monitor. Comment: Spironolactone may cause false elevation of digoxin assay.
  
  spironolactone and digoxin both increase serum potassium. Modify Therapy/Monitor Closely.

• squill

  Contraindicated (1)squill, digoxin. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.

• St John's Wort

  Monitor Closely (2)St John's Wort will decrease the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  St John's Wort decreases levels of digoxin by increasing metabolism. Use Caution/Monitor.

• stiripentol

  Monitor Closely (1)stiripentol will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Consider reducing the dose of P-glycoprotein (P-gp) substrates, if adverse reactions are experienced when administered concomitantly with stiripentol.

• streptomycin

  Monitor Closely (1)streptomycin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• succinylcholine

  Monitor Closely (2)succinylcholine, digoxin. Mechanism: unknown. Use Caution/Monitor. Increased risk of cardiac arrhythmias.
  
  digoxin and succinylcholine both increase serum potassium. Use Caution/Monitor.

• sucralfate

  Serious - Use Alternative (1)sucralfate will decrease the level or effect of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Measure serum digoxin concentrations before initiating concomitant drugs; continue monitoring and increase digoxin dose by approximately 20% to 40% as necessary

• sulfadiazine

  Monitor Closely (1)sulfadiazine will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• sulfamethoxazole

  Monitor Closely (2)sulfamethoxazole will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.
  
  sulfamethoxazole will increase the level or effect of digoxin by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.

• sulfasalazine

  Monitor Closely (2)sulfasalazine decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Sulfasalazine >2 g/day.
  
  sulfasalazine and digoxin both increase serum potassium. Use Caution/Monitor.

• sulfisoxazole

  Monitor Closely (1)sulfisoxazole will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• sulindac

  Monitor Closely (1)sulindac and digoxin both increase serum potassium. Use Caution/Monitor.

• suvorexant

  Monitor Closely (1)suvorexant will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Suvorexant may cause a slight increase in digoxin levels

• tacrolimus

  Monitor Closely (1)tacrolimus will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• teduglutide

  Monitor Closely (1)teduglutide increases levels of digoxin by Other (see comment). Use Caution/Monitor. Comment: Teduglutide may increase absorption of concomitant PO medications; caution with with drugs requiring titration or those with a narrow therapeutic index; dose adjustment may be necessary.

• teicoplanin

  Monitor Closely (1)teicoplanin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• telmisartan

  Monitor Closely (2)telmisartan increases levels of digoxin by unknown mechanism. Use Caution/Monitor.
  
  telmisartan and digoxin both increase serum potassium. Use Caution/Monitor.

• temocillin

  Monitor Closely (1)temocillin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• tenofovir DF

  Monitor Closely (1)tenofovir DF increases levels of digoxin by decreasing renal clearance. Use Caution/Monitor. Potential for increased toxicity. .

• tepotinib

  Serious - Use Alternative (1)tepotinib will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If concomitant use unavoidable, reduce the P-gp substrate dosage if recommended in its approved product labeling.

• terbutaline

  Monitor Closely (1)digoxin increases and terbutaline decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• teriparatide

  Monitor Closely (1)teriparatide increases toxicity of digoxin by Other (see comment). Use Caution/Monitor. Comment: Transient hypercalcemia may predispose to digoxin toxicity (rare case reports).

• tetracycline

  Monitor Closely (1)tetracycline will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• thyroid desiccated

  Monitor Closely (1)thyroid desiccated decreases effects of digoxin by unknown mechanism. Use Caution/Monitor.

• ticagrelor

  Monitor Closely (1)ticagrelor increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Ticagrelor inhibits P-glycoprotein transporter. Monitor digoxin levels with initiation of or any change in ticagrelor therapy.

• ticarcillin

  Monitor Closely (1)ticarcillin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• tigecycline

  Monitor Closely (1)tigecycline will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.Minor (1)tigecycline decreases levels of digoxin by unspecified interaction mechanism. Minor/Significance Unknown.

• timolol

  Monitor Closely (2)timolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.
  
  timolol and digoxin both increase serum potassium. Use Caution/Monitor.Serious - Use Alternative (1)digoxin, timolol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

• tipranavir

  Monitor Closely (1)tipranavir increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Potential for increased toxicity. .

• tobramycin

  Monitor Closely (1)tobramycin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• tolfenamic acid

  Monitor Closely (1)tolfenamic acid and digoxin both increase serum potassium. Use Caution/Monitor.

• tolmetin

  Monitor Closely (1)tolmetin and digoxin both increase serum potassium. Use Caution/Monitor.

• tolvaptan

  Monitor Closely (2)tolvaptan will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  digoxin and tolvaptan both increase serum potassium. Use Caution/Monitor.

• topiramate

  Minor (1)topiramate decreases levels of digoxin by unspecified interaction mechanism. Minor/Significance Unknown.

• torsemide

  Monitor Closely (2)torsemide increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Hypokalemia increases digoxin effects.
  
  digoxin increases and torsemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• trandolapril

  Monitor Closely (1)trandolapril increases levels of digoxin by unspecified interaction mechanism. Use Caution/Monitor.

• trazodone

  Monitor Closely (2)trazodone will decrease the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  trazodone increases levels of digoxin by unspecified interaction mechanism. Use Caution/Monitor.

• triamterene

  Monitor Closely (2)digoxin will increase the level or effect of triamterene by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
  
  triamterene and digoxin both increase serum potassium. Modify Therapy/Monitor Closely.

• trimagnesium citrate anhydrous

  Monitor Closely (1)digoxin decreases effects of trimagnesium citrate anhydrous by increasing renal clearance. Use Caution/Monitor.

• trimethoprim

  Monitor Closely (2)trimethoprim will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.
  
  digoxin will increase the level or effect of trimethoprim by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.

• trofinetide

  Serious - Use Alternative (1)trofinetide will increase the level or effect of digoxin by Other (see comment). Avoid or Use Alternate Drug. Trofinetide (an OATP131 and OATP13B inhibitor) may increase plasma levels of OATP131 or OATP13B substrates. Avoid coadministration with sensitive substrates.

• trospium chloride

  Monitor Closely (1)digoxin, trospium chloride. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

• tucatinib

  Monitor Closely (1)tucatinib will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Consider reducing the dosage of P-gp substrates, where minimal concentration changes may lead to serious or life-threatening toxicities.

• ulipristal

  Monitor Closely (1)ulipristal increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• ustekinumab

  Monitor Closely (1)ustekinumab, digoxin. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, normalizing the formation of CYP450 enzymes. Upon initiation or discontinuation of ustekinumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

• valsartan

  Monitor Closely (1)valsartan will increase the level or effect of digoxin by decreasing renal clearance. Use Caution/Monitor. Monitor digoxin levels closely when coadministered with drugs that may decrease glomerular filtration or tubular secretion.

• vanadium

  Minor (1)vanadium increases effects of digoxin by pharmacodynamic synergism. Minor/Significance Unknown.

• vancomycin

  Monitor Closely (1)vancomycin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• vandetanib

  Serious - Use Alternative (1)vandetanib increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

• vemurafenib

  Monitor Closely (1)vemurafenib increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• venetoclax

  Serious - Use Alternative (1)venetoclax will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. In vitro data suggest venetoclax may inhibit P-gp substrates at therapeutic dose levels in the gut. Avoid coadministration of narrow therapeutic index P-gp substrates with venetoclax. If a narrow therapeutic index P-gp substrate must be used, it should be taken at least 6 hr before venetoclax.

• verapamil

  Monitor Closely (2)verapamil will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Toxicity characterized by gastrointestinal and neuropsychiatric symptoms, and cardiac arrhythmias may result.
  
  digoxin will increase the level or effect of verapamil by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.Serious - Use Alternative (1)verapamil increases levels of digoxin by decreasing renal clearance. Avoid or Use Alternate Drug.

• vincristine

  Monitor Closely (1)vincristine decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

• vincristine liposomal

  Monitor Closely (1)vincristine liposomal decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

• vitamin D

  Monitor Closely (1)vitamin D increases toxicity of digoxin by Other (see comment). Use Caution/Monitor. Comment: Vitamin D may cause hypercalcemia which may affect the actions of digoxin and/or lead to cardiac arrhythmias.