Drug interactions
Azithromycin + Digoxin
Severity: Moderate
Azithromycin and Digoxin: moderate interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Azithromycin can raise serum digoxin concentrations and has been associated with digoxin toxicity, including nausea, arrhythmias and visual disturbance. The effect is most relevant in older patients and those with renal impairment.
What this interaction means in plain words
Azithromycin and Digoxin can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Azithromycin belongs to Anti Bacterial; Digoxin belongs to Cardiovascular.
Why it happens
Azithromycin inhibits P-glycoprotein-mediated digoxin efflux and may reduce gut bacterial inactivation of digoxin, increasing its absorption and exposure.
What to do
Monitor digoxin serum levels, ECG and symptoms of toxicity when starting or stopping azithromycin. Reduce the digoxin dose if levels rise.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Azithromycin
- Azithromycin + Cisapride Contraindicated
- Azithromycin + Domperidone Contraindicated
- Azithromycin + Dronedarone Contraindicated
- Azithromycin + Pimozide Contraindicated
- Azithromycin + Piperaquine Contraindicated
- Azithromycin + Thioridazine Contraindicated
Other interactions of Digoxin
- Digoxin + Lily of the valley Contraindicated
- Digoxin + Squill Contraindicated
- Adagrasib + Digoxin Major
- Amiodarone + Digoxin Major
- Amlodipine-hydrochlorothiazide-valsartan + Digoxin Major
- Amphotericin b deoxycholate + Digoxin Major
Frequently asked questions
Can I take Azithromycin with Digoxin?
MediHelp rates the interaction as moderate. Azithromycin and Digoxin can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Azithromycin can raise serum digoxin concentrations and has been associated with digoxin toxicity, including nausea, arrhythmias and visual disturbance. The effect is most relevant in older patients and those with renal impairment.
How serious is the interaction between Azithromycin and Digoxin?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor digoxin serum levels, ECG and symptoms of toxicity when starting or stopping azithromycin. Reduce the digoxin dose if levels rise.
What other medicines interact with Azithromycin?
MediHelp also lists interactions of Azithromycin with, for example, Cisapride, Domperidone, Dronedarone. The full list is on the Azithromycin page.
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