Drug interactions
Cobicistat + Digoxin
Severity: Major
Cobicistat and Digoxin: major interaction.
Last updated Sources: US FDA label
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
Cobicistat inhibits intestinal and renal P-glycoprotein and can raise digoxin concentrations. Digoxin has a narrow therapeutic index, so toxicity such as nausea, arrhythmias and bradycardia may result.
What this interaction means in plain words
Cobicistat and Digoxin can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Cobicistat belongs to Miscellaneous; Digoxin belongs to Cardiovascular.
Why it happens
Cobicistat inhibits P-glycoprotein, increasing digoxin absorption and reducing its renal and biliary elimination.
What to do
Measure digoxin concentration before starting cobicistat, then start with a reduced digoxin dose and titrate to levels and response. Monitor ECG and for signs of toxicity.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
Pro+ members
Unlock the full page
Create an account and start a Pro+ trial to unlock the full management advice for Cobicistat and Digoxin, the additional notes, the evidence detail and the whole-prescription interaction checker.
- Full clinical management advice
- Additional notes
- Evidence detail
- Interaction checker for a whole prescription
Try Pro+ free for 7 days on the web. No card needed.
References
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
Other interactions of Cobicistat
- Alfuzosin + Cobicistat Contraindicated
- Apalutamide + Cobicistat Contraindicated
- Cobicistat + Colchicine Contraindicated
- Cobicistat + Dronedarone Contraindicated
- Cobicistat + Eletriptan Contraindicated
- Cobicistat + Eplerenone Contraindicated
Frequently asked questions
Can I take Cobicistat with Digoxin?
MediHelp rates the interaction as major. Cobicistat and Digoxin can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Cobicistat inhibits intestinal and renal P-glycoprotein and can raise digoxin concentrations. Digoxin has a narrow therapeutic index, so toxicity such as nausea, arrhythmias and bradycardia may result.
How serious is the interaction between Cobicistat and Digoxin?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Measure digoxin concentration before starting cobicistat, then start with a reduced digoxin dose and titrate to levels and response. Monitor ECG and for signs of toxicity.
What other medicines interact with Digoxin?
MediHelp also lists interactions of Digoxin with, for example, Lily of the valley, Squill, Adagrasib. The full list is on the Digoxin page.
Full monographs, dosing and an interaction checker in the MediHelp app
Open the complete reference, check multi-drug interactions and use dosing tools in the MediHelp app.
