Interactions

Drug-Drug

• Thiazide and loop diuretics, piperacillin , ticarcillin, amphotericin B, and corticosteroids, and excessive use of laxatives may cause hypokalemia which may risk of toxicity

• Amiodarone, some benzodiazepines, cyclosporine, diphenoxylate, indomethacin, itraconazole, propafenone, propantheline, quinidine, quinine, spironolactone and verapamil may serum levels and may lead to toxicity (serum level monitoring/dose reduction may be required)

• Blood levels may be by oral aminoglycosides, some antineoplastics (bleomycin, carmustine, cyclophosphamide, cytarabine, doxorubicin, methotrexate, procarbazine, vincristine), activated charcoal, cholestyramine, colestipol, kaolin/pectin, metoclopramide, penicillamine, rifampin or sulfasalazine

• In a small percentage (10%) of patients gut bacteria metabolize digoxin to inactive compounds; macrolide anti-infectives (erythromycin, azithromycin, clarithromycin), tetracyclines, by killing these bacteria, will cause digoxin levels and toxicity; dose may need to be for up to 9 weeks

• Additive bradycardia may occur with beta blockers and other antiarrhythmics (quinidine, disopyramide)

• Concurrent use of sympathomimetics may risk of arrthythmias

• Thyroid hormones may therapeutic effects

Drug-Natural Products

• Licorice and stimulant natural products (aloe) may risk of potassium depletion

• St. John's wort may digoxin levels and effect

Drug-Food
Concurrent ingestion of a high-fiber meal may absorption. Administer digoxin 1 hour before or 2 hours after such a meal

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