A nurse is caring for a client who is taking digoxin for heart failure and develops indications

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Monitor Closely (2)atenolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.

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

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

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

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

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

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

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

Monitor Closely (2)bendroflumethiazide increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Hypokalemia increases digoxin effects.

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

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

Monitor Closely (2)betaxolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.

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

Monitor Closely (2)bisoprolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.

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

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

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

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

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

Monitor Closely (2)bumetanide increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Hypokalemia increases digoxin effects.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Monitor Closely (2)celiprolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.

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

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

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

Monitor Closely (2)chlorothiazide increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Hypokalemia increases digoxin effects.

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

Monitor Closely (2)chlorthalidone increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Hypokalemia increases digoxin effects.

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

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

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

Minor (2)cimetidine will increase the level or effect of digoxin by increasing gastric pH. Applies only to oral form of both agents. Minor/Significance Unknown.

cimetidine will increase the level or effect of digoxin by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.

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

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

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

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

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

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

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

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

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

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

Monitor Closely (2)cyclopenthiazide increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Hypokalemia increases digoxin effects.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Monitor Closely (2)esmolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.

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

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

Monitor Closely (2)ethacrynic acid increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Hypokalemia increases digoxin effects.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Monitor Closely (2)furosemide increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Hypokalemia increases digoxin effects.

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

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

Monitor Closely (2)gentamicin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

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

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

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

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

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

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

Monitor Closely (3)digoxin will increase the level or effect of hydrochlorothiazide by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor. hydrochlorothiazide increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Hypokalemia increases digoxin effects.

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

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

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

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

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

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

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

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

Monitor Closely (2)indapamide increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Hypokalemia increases digoxin effects.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Monitor Closely (2)labetalol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Monitor Closely (3)digoxin will increase the level or effect of methyclothiazide by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor. methyclothiazide increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Hypokalemia increases digoxin effects.

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

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

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

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

Monitor Closely (2)metolazone increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Hypokalemia increases digoxin effects.

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

Monitor Closely (2)metoprolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.

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

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

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

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

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

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

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

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

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

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

Monitor Closely (2)nadolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.

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

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

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

Monitor Closely (2)nebivolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Monitor Closely (2)ofloxacin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Monitor Closely (2)penbutolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.

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

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

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

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

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

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

Monitor Closely (2)pindolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Monitor Closely (2)propranolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.

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

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

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

Serious - Use Alternative (2)quinidine will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

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

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

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

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

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

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

ranolazine increases levels of digoxin by decreasing metabolism. Use Caution/Monitor. Ranolazine inhibits P glycoprotein.

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

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

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

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

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

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

ritonavir increases levels of digoxin by decreasing hepatic clearance. Use Caution/Monitor.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Monitor Closely (2)sotalol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.

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

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

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

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

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

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

St John's Wort decreases levels of digoxin by increasing metabolism. Use Caution/Monitor.

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

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

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

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

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

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

Monitor Closely (2)sulfamethoxazole will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

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

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

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

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

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

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

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

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

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

Monitor Closely (2)telmisartan increases levels of digoxin by unknown mechanism. Use Caution/Monitor.

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

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

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

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

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

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

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

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

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

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

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

Monitor Closely (2)timolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.

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

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

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

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

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

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

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

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

Monitor Closely (2)torsemide increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Hypokalemia increases digoxin effects.

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

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

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

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

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

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

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

Monitor Closely (2)trimethoprim will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

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

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

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

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

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

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

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

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

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

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

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

Monitor Closely (2)verapamil will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Toxicity characterized by gastrointestinal and neuropsychiatric symptoms, and cardiac arrhythmias may result.

digoxin will increase the level or effect of verapamil by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.Serious - Use Alternative (1)verapamil increases levels of digoxin by decreasing renal clearance. Avoid or Use Alternate Drug.

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

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

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