Drug interactions
Digoxin + Erythromycin ethylsuccinate
Severity: Major
Digoxin and Erythromycin ethylsuccinate: 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
Oral erythromycin can raise digoxin levels, sometimes substantially, with reported toxicity. The effect is most relevant in patients with a high degree of gut bacterial inactivation of digoxin.
What this interaction means in plain words
Digoxin and Erythromycin ethylsuccinate 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.
Why it happens
Erythromycin reduces gut flora metabolism of digoxin and inhibits P-glycoprotein, increasing digoxin bioavailability and reducing clearance.
What to do
Monitor digoxin concentrations and ECG during and after the macrolide course. Reduce the digoxin dose if levels rise, or choose a non-interacting antibiotic.
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?
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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
Frequently asked questions
Can I take Digoxin with Erythromycin ethylsuccinate?
MediHelp rates the interaction as major. Digoxin and Erythromycin ethylsuccinate 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. Oral erythromycin can raise digoxin levels, sometimes substantially, with reported toxicity. The effect is most relevant in patients with a high degree of gut bacterial inactivation of digoxin.
How serious is the interaction between Digoxin and Erythromycin ethylsuccinate?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor digoxin concentrations and ECG during and after the macrolide course. Reduce the digoxin dose if levels rise, or choose a non-interacting antibiotic.
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.
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