Dosing & Uses
Dosage Forms & Strengths
oral solution
- 0.05mg/mL
injectable solution
- 0.1mg/mL
- 0.25mg/mL
tablet
- 0.0625mg (Lanoxin only)
- 0.125mg
- 0.1875mg (Lanoxin only)
- 0.25mg
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
Dosage Forms & Strengths
oral solution
- 0.05mg/mL
injectable solution
- 0.1mg/mL
- 0.25mg/mL
tablet
- 0.125mg
- 0.25mg
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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (1)
- squill
squill, digoxin. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.
Serious - Use Alternative (58)
- 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.
- 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.
- 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 (298)
- 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.
- 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.
- 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.
- 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.
- 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%.
- 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.
Adverse Effects
1-10%
Dizziness (4.9%)
Mental disturbances (4.1%)
Diarrhea (3.2%)
Headache (3.2%)
Nausea (3.2%)
Vomiting (1.6%)
Maculopapular rash (1.6%)
<1%
Anorexia
Cardiac dysrhythmia
Arrhythmia in children (consider a toxicity)
Frequency Not Defined
Visual disturbance (blurred or yellow vision)
Heart block (1°/2°/3°)
Asystole
Tachycardia
Warnings
Contraindications
Hypersensitivity
Ventricular fibrillation
Cautions
Use caution in chronic constrictive pericarditis, electrical cardioversion, severe bradycardia, severe heart failure, severe pulmonary disease, sick sinus syndrome, ventricular tachycardia, ventricular premature contractions, Wolff-Parkinson-White syndrome, electrolyte imbalance, hypothyroidism or hyperthyroidism, hypoxia, idiopathic hypertrophic subaortic stenosis, renal disease, concomitant diuretics
Not recommended in patients with acute myocardial infarction
Avoid in patients with myocarditis
Risk of advanced or complete heart block in patients with sinus node disease and AV block
Very narrow margin between effective therapeutic and toxic dosages: Therapeutic range, 0.5-2 ng/mL (target 0.5-1 ng/mL); toxic range, >2.5 ng/mL
Generally avoid if left ventricular systolic function preserved, although may be used for ventricular rate control in subgroup with chronic atrial fibrillation
Less effective in presence of hypokalemia or hypocalcemia; avoid hypercalcemia or hypomagnesemia, which may predispose to serious arrhythmias
Heart failure patients with preserved ventricular function, including acute cor pulmonale, amyloid heart disease, and constrictive pericarditis may be susceptible to digoxin toxicity
May cause false-positive ST-T changes during exercise testing
Do not switch between different PO forms or between brand and generic forms of digoxin; bioavailability varies
Serum levels drawn within 6-8 hours of dose will be falsely high because of prolonged distribution phase
Increased risk of estrogen-like effects in geriatric patients
Beriberi heart disease may not respond adequately if underlying thiamine deficiency not corrected
Atrial arrhythmias are difficult to treat if associated with hypermetabolic (hyperthyroidism) or hyperdynamic (hypoxia) states; treat underlying condition before initiating therapy
Avoid extravasation; ensure proper needle or catheter placement prior to and during administration
Monitor for proarrhythmic effects, especially with digoxin toxicity
Use caution in patients with acute myocardial infarction; may increase myocardial oxygen demand; during acute coronary syndrome, digoxin administered IV may be used to slow a rapid ventricular response and improve left ventricular function in the acute treatment of atrial fibrillation associated with severe LV function and heart failure or hemodynamic instability
Monitor serum concentration closely when used for rate control in patients with atrial fibrillation; serum concentration that is not properly controlled are associated with increased risk of mortality
Consider use of digoxin only in heart failure with reduced ejection fraction when symptoms remain despite guideline-directed medical therapy; withdrawal of digoxin in clinically stable patients with heart failure may lead to recurrence of heart failure symptoms
In hypertrophic cardiomyopathy, outflow obstruction may worsen due to positive inotropic effects of digoxin; avoid use unless used to control ventricular response with atrial fibrillation; in the absence of atrial fibrillation, digoxin is potentially harmful in the treatment of dyspnea in patients with hypertrophic cardiomyopathy
Avoid rapid IV administration in digitalized patients; may produce serious arrhythmias
Not necessary to routinely reduce or hold digoxin therapy prior to elective electrical cardioversion for atrial fibrillation; however, exclusion of digoxin toxicity is necessary prior to cardioversion; whithold digoxin and delay cardioversion until toxicity subsides if signs of digoxin excess exist
Pregnancy & Lactation
Pregnancy
Experience with digoxin in pregnant women over several decades, based on published retrospective clinical studies and case reports, has not led to the identification of a drug associated risk of major birth defects, miscarriage or adverse maternal and fetal outcomes
Untreated underlying maternal conditions (eg, heart failure, atrial fibrillation) during pregnancy pose a risk to the mother and fetus
Clinical considerations
- Pregnant women with heart failure are at increased risk for preterm birth; clinical classification of heart disease may worsen with pregnancy and lead to maternal or fetal death
- Pregnant women with atrial fibrillation are at an increased risk of delivering a low birth weight infant; atrial fibrillation may worsen with pregnancy and can lead to maternal or fetal death
Fetal/neonatal adverse reactions
- Digoxin has been shown to cross the placenta and is found in amniotic fluid
- Monitor neonates for signs and symptoms of digoxin toxicity, including vomiting, and cardiac arrhythmias
Dose adjustments during pregnancy and the postpartum period
- Digoxin requirements may increase during pregnancy and decrease in the postpartum period
- Monitor serum digoxin levels during pregnancy and the postpartum period
Labor or delivery
- Risk of arrhythmias may increase during labor and delivery
- Monitor patients continuously during labor and delivery
Lactation
The digoxin dose received through breastfeeding is up to 4% of the neonatal maintenance dosage, which is unlikely to be clinically relevant
There are no data on the effects of digoxin on the breastfed infant or the effects on milk production
Data
- Based on data from 2 lactation studies in a total of 13 breastfed infants, digoxin concentrations in breast milk ranged between 0.4-1 ng/mL following 0.25 mg/day dose in lactating women
- The amount of digoxin ingested daily by breastfed infants is ~0.03- 0.16 mcg/kg/day
- This translates to a relative infant dose of digoxin between 1-7% of the maternal weight-adjusted dose and about 0.2-4% of the neonatal maintenance dose
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Digoxin inhibits Na-K ATPase, which in turn causes increased availability of intracellular calcium in the myocardium and conduction system. Inotropy and automaticity are subsequently increased while conduction velocity is reduced. Therapy indirectly causes parasympathetic stimulation of autonomic nervous system, with consequent effects on the sino-atrial (SA) and atrioventricular (AV) nodes.
Digoxin reduces catecholamine reuptake at nerve terminals, rendering blood vessels more sensitive to endogenous or exogenous catecholamines. Increases baroreceptor sensitization, with consequent increased carotid sinus nerve activity and enhanced sympathetic withdrawal for any given increment in mean arterial pressure. At higher concentration, increases sympathetic outflow from the central nervous system (CNS) to both cardiac and peripheral sympathetic nerves. It also allows progressive efflux of intracellular potassium, with consequent increase in serum potassium levels.
Absorption
Bioavailability: 60-80 % (tablet); 70-85% (elixir)
Onset: 0.5-2 hr (PO) for initial effect and 2-6 hr for maximal effect; 5-30 min (IV) for initial effect and 1.5-4 hr for maximal effect
Duration: 3-4 days
Peak serum time: 1-3 hr (PO)
Distribution
Protein bound: 20-25%
Vd: 6-7 L/kg
Metabolism
Metabolized by liver
Metabolites: Digoxigenin bisdigitoxoside, digoxigenin monodigitoxoside (active)
Elimination
Half-life: 1-3 days
Excretion: Urine (57-80%), feces (9-13%; includes bile)
Administration
IV Compatibilities
Solution: D5/½NS with potassium chloride 20 mEq, D5W, LR, ½NS, NS
Additive: Bretylium, cimetidine, floxacillin, furosemide, lidocaine, ranitidine, verapamil
Syringe: Heparin, milrinone
Y-site: Bivalirudin, ciprofloxacin, cisatracurium, dexmedetomidine, diltiazem, famotidine, fenoldopam, gatifloxacin, heparin with hydrocortisone, Hextend, inamrinone, linezolid, meperidine, meropenem, midazolam, milrinone, morphine sulfate, potassium chloride, remifentanil, tacrolimus, vitamins B and C
IV Incompatibilities
Additive: Dobutamine
Syringe: Doxapram
Y-site: Amphotericin B cholesteryl sulfate, amiodarone, fluconazole, foscarnet, insulin (beef, pork, and Humulin R[?]), propofol
IV Preparation
Dilute with 4-fold or greater volume of SWI, D5W, or NS
IV Administration
Administer slowly by direct IV injection over minimum of 5 minutes (longer if given undiluted)
Do not administer if precipitate present
Drug is severe skin irritant when given IV/IM and may cause severe local skin reaction with possible sloughing
Storage
Store at controlled room temperature
Protect from light
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Lanoxin oral - | 125 mcg (0.125 mg) tablet |  | |
| Lanoxin oral - | 250 mcg (0.25 mg) tablet |  | |
| Lanoxin oral - | 187.5 mcg (0.1875 mg) tablet |  | |
| Lanoxin oral - | 62.5 mcg (0.0625 mg) tablet |  | |
| Digitek oral - | 125 mcg (0.125 mg) tablet |  | |
| Digitek oral - | 250 mcg (0.25 mg) tablet |  | |
| Digox oral - | 250 mcg (0.25 mg) tablet |  | |
| Digox oral - | 125 mcg (0.125 mg) tablet |  | |
| digoxin injection - | 250 mcg/mL (0.25 mg/mL) solution |  | |
| digoxin injection - | 250 mcg/mL (0.25 mg/mL) solution |  | |
| digoxin injection - | 250 mcg/mL (0.25 mg/mL) solution |  | |
| digoxin oral - | 125 mcg (0.125 mg) tablet |  | |
| digoxin oral - | 250 mcg (0.25 mg) tablet |  | |
| digoxin oral - | 125 mcg (0.125 mg) tablet |  | |
| digoxin oral - | 125 mcg (0.125 mg) tablet |  | |
| digoxin oral - | 250 mcg (0.25 mg) tablet |  | |
| digoxin oral - | 250 mcg (0.25 mg) tablet |  | |
| digoxin oral - | 250 mcg (0.25 mg) tablet | | |
| digoxin oral - | 125 mcg (0.125 mg) tablet | | |
| digoxin oral - | 50 mcg/mL (0.05 mg/mL) solution |  | |
| digoxin oral - | 50 mcg/mL (0.05 mg/mL) solution |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
digoxin injection
NO MONOGRAPH AVAILABLE AT THIS TIME
USES: Consult your pharmacist.
HOW TO USE: Consult your pharmacist.
SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Consult your pharmacist.
DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.
NOTES: No monograph available at this time.
MISSED DOSE: Consult your pharmacist.
STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.
Information last revised July 2016. Copyright(c) 2022 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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