Treatment with drugs that slow cardiac conduction, cause bradycardia or arrhythmias may potentiate the cardiac adverse effects of digoxin; use combinations carefully and monitor cardiac function.
Treatment with drugs that inhibit or induce P‑glycoprotein (ABCB1) may increase the risk of adverse effects or decrease digoxin’s efficacy.
Use of beta blockers and digoxin increases risk of bradycardia and AV block - additive effect.
Use of digoxin and amiodarone increases risk of dysrhythmias and torsade de pointes as amiodarone blocks P-glycoprotein (ABCB1). Torsade de pointes might by facilitated by bradycardia caused by digoxin.
Use of digoxin and azoles, clarithromycin and some HIV-protease inhibitors increases risk of dysrhythmias by inhibition of P-glycoprotein (ABCB1).
Use of digoxin and non-dihydropyridine calcium channel blockers increases risk of bradycardia, asystole and sinus arrest by inhibition of P-glycoprotein (ABCB1) and their synergistic effect on the heart.
Use of digoxin and loop or thiazide diuretics, amphotericin B, corticosteroids increase risk of dysrhythmias as hypokalaemia potentiates digoxin toxicity.
Use of digoxin and IV calcium increases risk of dysrhythmias as hypercalcemia increases effect of cardiac glycosides.
Use of digoxin and propafenone increases risk of dysrhythmia probably by inhibition of P-glycoprotein (ABCB1) by propafenone.
P‑glycoprotein (ABCB1)-inducers: Carbamazepine; phenytoin; rifampicin; St John’s wort; tipranavir.
P‑glycoprotein (ABCB1)-inhibitors: Amiodarone, azithromycin, carvedilol, ciclosporin, clarithromycin, cobicistat, daclatasvir, erythromycin, everolimus, glecaprevir with pibrentasvir, isavuconazole, itraconazole, ketoconazole, lapatinib, ledipasvir, ritonavir, ticagrelor, tolvaptan, vandetanib, velpatasvir, vemurafenib, venetoclax, verapamil.
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