digoxin (Rx)

Brand and Other Names:Lanoxin
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Dosing & Uses

AdultPediatric

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

  • 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
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Interactions

Interaction Checker

and digoxin

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            Contraindicated (1)

            • squill

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

            Serious - Use Alternative (57)

            • 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.

            • 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 (292)

            • 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.

            • 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.

            • 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.

            • flucloxacillin

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

            • 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.

            • 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.

            • 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.

            • 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.

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            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

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            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

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            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.

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            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)

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            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

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            Lanoxin oral
            -
            250 mcg (0.25 mg) tablet
            Lanoxin oral
            -
            125 mcg (0.125 mg) tablet
            Lanoxin oral
            -
            187.5 mcg (0.1875 mg) tablet
            Lanoxin oral
            -
            62.5 mcg (0.0625 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
            -
            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
            -
            125 mcg (0.125 mg) tablet
            digoxin oral
            -
            250 mcg (0.25 mg) tablet
            digoxin oral
            -
            50 mcg/mL (0.05 mg/mL) solution
            digoxin oral
            -
            50 mcg/mL (0.05 mg/mL) solution
            Digitek oral
            -
            250 mcg (0.25 mg) tablet
            Digitek oral
            -
            125 mcg (0.125 mg) tablet
            Digox oral
            -
            125 mcg (0.125 mg) tablet
            Digox oral
            -
            250 mcg (0.25 mg) tablet

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Select a drug:
            Patient Education
            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) 2021 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.

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.