Drug interactions
Digoxin + Gentamicin
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.
Overview
Gentamicin-associated acute kidney injury can reduce renal clearance of digoxin, increasing digoxin concentrations and toxicity risk; gentamicin may also cause hypokalemia/hypomagnesemia, further predisposing to digoxin-induced arrhythmias.
Mechanism of action
Pharmacokinetic: Reduced digoxin renal clearance with aminoglycoside-induced nephrotoxicity. Pharmacodynamic: Electrolyte disturbances (K+/Mg2+ wasting) increase myocardial sensitivity to digoxin.
Clinical management
Before and during concomitant therapy, monitor SCr/eGFR and electrolytes at baseline and at least every 2–3 days; obtain serum digoxin concentrations within ~5–7 days of starting gentamicin and with any renal function change; reduce/hold digoxin per renal function and levels; correct K+ and Mg2+.
Drug reference
References
- Gentamicin Injection Prescribing Information — FDA Label
- Digoxin: Patient selection, dosing, and monitoring — UpToDate
- Aminoglycosides: Nephrotoxicity — UpToDate
Frequently asked questions
Can I take Digoxin with Gentamicin?
The interaction is rated: Major. Gentamicin-associated acute kidney injury can reduce renal clearance of digoxin, increasing digoxin concentrations and toxicity risk; gentamicin may also cause hypokalemia/hypomagnesemia, further predisposing to digoxin-induced arrhythmias.
How serious is the interaction between Digoxin and Gentamicin?
The interaction is rated: Major. Evidence level: High.
How is the interaction between Digoxin and Gentamicin managed?
Before and during concomitant therapy, monitor SCr/eGFR and electrolytes at baseline and at least every 2–3 days; obtain serum digoxin concentrations within ~5–7 days of starting gentamicin and with any renal function change; reduce/hold digoxin per renal function and levels; correct K+ and Mg2+.
Why do Digoxin and Gentamicin interact?
Pharmacokinetic: Reduced digoxin renal clearance with aminoglycoside-induced nephrotoxicity. Pharmacodynamic: Electrolyte disturbances (K+/Mg2+ wasting) increase myocardial sensitivity to digoxin.
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.