Meta Information
ID:digoxin
Name:
Schema Version:AIM-2.0
Interactions
Target id:
/condition/renal-impairment
Target name:
Renal Impairment
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Digoxin is primarily cleared by the kidneys, so impaired renal function significantly reduces its excretion, leading to accumulation and a high risk of toxicity.
Actionable advice:
Avoid use or use with extreme caution and dose reduction in renal impairment; requires frequent monitoring of digoxin levels and kidney function.
Target id:
/class/potassium-lowering-agents
Target name:
Potassium-Lowering Agents (e.g., Loop/Thiazide Diuretics)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Low potassium levels (hypokalemia) increase the sensitivity of the heart muscle to digoxin, dramatically increasing the risk of serious arrhythmias and toxicity.
Actionable advice:
Monitor serum potassium levels closely and maintain them in the normal range when co-administering with drugs like furosemide or hydrochlorothiazide.
Target id:
/class/p-glycoprotein-inhibitors
Target name:
P-glycoprotein (P-gp) Inhibitors
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
These drugs (e.g., amiodarone, verapamil, quinidine, clarithromycin, itraconazole) block the P-gp transporter responsible for pumping digoxin out of cells and into the urine, causing digoxin levels to rise to toxic concentrations.
Actionable advice:
Avoid combination if possible; if necessary, reduce the digoxin dose by 25-50% and monitor digoxin levels closely when starting or stopping a P-gp inhibitor.
Target id:
/class/bradycardic-agents
Target name:
Drugs that Slow Heart Rate
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Combining digoxin with other drugs that slow the heart rate (e.g., beta-blockers, diltiazem, verapamil, amiodarone) can lead to an excessive decrease in heart rate (bradycardia) or heart block.
Actionable advice:
Use this combination with caution and monitor heart rate and ECG regularly for additive effects.
Target id:
/class/calcium-supplements
Target name:
Calcium Supplements
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
High calcium levels (hypercalcemia) increase the risk of digoxin toxicity and can lead to serious cardiac arrhythmias. The risk is highest with intravenous calcium administration.
Actionable advice:
Avoid intravenous calcium in patients on digoxin; use oral calcium supplements cautiously and monitor serum calcium levels.
Target id:
/class/bile-acid-sequestrants
Target name:
Bile Acid Sequestrants & Binders
Severity:
major
Interaction type:
diminishing
Nature:
temporal
Temporal spacing:
Hours before target:
4
Hours after target:
4
Description:
Drugs like cholestyramine and colestipol can bind to digoxin in the gut, preventing its absorption and reducing its effectiveness.
Actionable advice:
Administer digoxin at least 4 hours before or 4 hours after taking a bile acid sequestrant.
Target id:
/intervention/saint-johns-wort
Target name:
Saint John's Wort
Severity:
major
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
null
Description:
St. John's Wort is a potent inducer of the P-glycoprotein (P-gp) transporter, which increases the elimination of digoxin from the body, leading to lower blood levels and reduced therapeutic effect.
Actionable advice:
Avoid taking St. John's Wort completely while on digoxin therapy.
Target id:
/class/p-glycoprotein-inducers
Target name:
P-glycoprotein (P-gp) Inducers
Severity:
major
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
null
Description:
These drugs (e.g., rifampin, certain anticonvulsants) enhance the activity of the P-gp transporter, accelerating digoxin clearance and reducing its concentration and effectiveness.
Actionable advice:
Avoid combination if possible; if necessary, monitor digoxin levels and clinical response closely and adjust digoxin dose as needed.
Target id:
/class/antacids
Target name:
Multivalent Cation Antacids
Severity:
moderate
Interaction type:
diminishing
Nature:
temporal
Temporal spacing:
Hours before target:
2
Hours after target:
2
Description:
Antacids containing aluminum, magnesium, or calcium can bind to digoxin in the gastrointestinal tract, reducing its absorption.
Actionable advice:
Separate digoxin administration from antacids by at least 2 hours.
Target id:
/class/antibiotics-long-term
Target name:
Antibiotics (e.g., Macrolides, Tetracyclines)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
In about 10% of patients, gut bacteria metabolize a significant portion of digoxin. Antibiotics can kill these bacteria, leading to increased digoxin absorption and potential toxicity.
Actionable advice:
Monitor for signs of digoxin toxicity when starting a course of antibiotics, especially macrolides or tetracyclines.
Target id:
/condition/thyroid-disorders
Target name:
Thyroid Disorders
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Hypothyroidism can decrease digoxin clearance, requiring a lower dose, while hyperthyroidism can increase clearance, requiring a higher dose. Changes in thyroid status can alter digoxin levels.
Actionable advice:
Monitor digoxin levels closely when thyroid status changes or when thyroid hormone therapy is initiated or adjusted.
Target id:
/class/proton-pump-inhibitors
Target name:
Proton Pump Inhibitors
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Long-term use of PPIs can cause low magnesium levels (hypomagnesemia), which, similar to low potassium, increases the risk of digoxin toxicity.
Actionable advice:
Periodically monitor serum magnesium levels in patients on long-term PPI therapy who are also taking digoxin.
Target id:
/dietary/high-fiber-meal
Target name:
High-Fiber Meal
Severity:
moderate
Interaction type:
diminishing
Nature:
temporal
Temporal spacing:
Hours before target:
2
Hours after target:
2
Description:
High-fiber foods, particularly bran, can bind to digoxin in the gut and reduce its absorption, potentially lowering its effectiveness.
Actionable advice:
Separate digoxin doses from high-fiber meals by at least 2 hours, or maintain a consistent intake pattern relative to meals.
Target id:
/class/viscous-fibers
Target name:
Gel-Forming Viscous Fibers
Severity:
moderate
Interaction type:
diminishing
Nature:
temporal
Temporal spacing:
Hours before target:
2
Hours after target:
2
Description:
Supplements like psyllium husk can decrease the absorption of digoxin from the gastrointestinal tract, reducing its bioavailability.
Actionable advice:
Take digoxin at least 2 hours before or 2 hours after taking psyllium or other fiber supplements.
Target id:
/intervention/licorice-root
Target name:
Licorice Root
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Licorice (containing glycyrrhizin) can cause pseudoaldosteronism, leading to sodium retention, potassium loss, and hypertension, thereby increasing the risk of digoxin toxicity due to hypokalemia.
Actionable advice:
Avoid consuming licorice root or large amounts of black licorice candy while taking digoxin.
Target id:
/class/potassium-sparing-diuretics
Target name:
Potassium-Sparing Diuretics
Severity:
moderate
Interaction type:
assay_interference
Nature:
absolute
Temporal spacing:
null
Description:
Spironolactone can increase digoxin levels by inhibiting its secretion, but it and its metabolites can also interfere with certain digoxin assays, causing falsely elevated readings.
Actionable advice:
Be aware of the dual interaction; inform the lab you are taking spironolactone when getting digoxin levels checked.
Target id:
/condition/geriatric
Target name:
Geriatric (Older Adults)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Older adults typically have reduced kidney function (even with normal serum creatinine), lower body weight, and are more sensitive to the effects and toxicity of digoxin.
Actionable advice:
Use lower doses and monitor closely for toxicity in older adults.
Target id:
/intervention/panax-ginseng
Target name:
Panax Ginseng
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
There are conflicting reports, but some evidence suggests ginseng may slightly increase digoxin levels, possibly by inhibiting P-glycoprotein. It can also interfere with some digoxin assays.
Actionable advice:
Use with caution and inform your doctor if you start or stop taking ginseng supplements.
Target id:
/biomarker/serum-potassium
Target name:
Serum Potassium
Severity:
major
Interaction type:
requirement
Nature:
absolute
Temporal spacing:
null
Description:
Maintaining normal potassium levels is critical to prevent digoxin toxicity. Both low (increases toxicity) and high (decreases efficacy) levels are problematic.
Actionable advice:
Regularly monitor serum potassium levels as directed by your healthcare provider.
Target id:
/biomarker/egfr
Target name:
Estimated Glomerular Filtration Rate
Severity:
major
Interaction type:
requirement
Nature:
absolute
Temporal spacing:
null
Description:
Kidney function (eGFR) determines how quickly digoxin is cleared from the body. Regular monitoring is essential for dose adjustments.
Actionable advice:
Regularly monitor kidney function (eGFR/creatinine) as directed by your healthcare provider.
Target id:
/biomarker/rbc-magnesium
Target name:
RBC Magnesium
Severity:
major
Interaction type:
requirement
Nature:
absolute
Temporal spacing:
null
Description:
Low magnesium levels (hypomagnesemia) increase the risk of digoxin-induced arrhythmias and toxicity.
Actionable advice:
Regularly monitor serum or RBC magnesium levels as directed by your healthcare provider.
Target id:
/biomarker/digoxin-level
Target name:
Serum Digoxin Level
Severity:
major
Interaction type:
requirement
Nature:
absolute
Temporal spacing:
null
Description:
Due to its narrow therapeutic index, blood levels of digoxin must be monitored to ensure they are within the effective and safe range (typically 0.5-0.9 ng/mL for heart failure).
Actionable advice:
Get serum digoxin levels checked as scheduled, typically 6-8 hours after the last dose.