Drug interactions
Digoxin + Ketoconazole
Severity: Moderate
Digoxin and Ketoconazole: 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
Ketoconazole may increase serum digoxin concentrations, raising the risk of digoxin toxicity such as arrhythmias, nausea and visual disturbances. Digoxin has a narrow therapeutic index.
What this interaction means in plain words
Digoxin and Ketoconazole 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.
Digoxin belongs to Cardiovascular; Ketoconazole belongs to Anti Fungals.
Why it happens
Ketoconazole inhibits P-glycoprotein, reducing digoxin renal and intestinal efflux.
What to do
Monitor serum digoxin concentrations and ECG when starting or stopping ketoconazole. 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 Ketoconazole
- Alfuzosin + Ketoconazole Contraindicated
- Alprazolam + Ketoconazole Contraindicated
- Avanafil + Ketoconazole Contraindicated
- Conivaptan + Ketoconazole Contraindicated
- Dihydroergotamine intranasal + Ketoconazole Contraindicated
- Dihydroergotamine + Ketoconazole 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 Digoxin with Ketoconazole?
MediHelp rates the interaction as moderate. Digoxin and Ketoconazole 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. Ketoconazole may increase serum digoxin concentrations, raising the risk of digoxin toxicity such as arrhythmias, nausea and visual disturbances. Digoxin has a narrow therapeutic index.
How serious is the interaction between Digoxin and Ketoconazole?
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 serum digoxin concentrations and ECG when starting or stopping ketoconazole. Reduce the digoxin dose if levels rise.
What other medicines interact with Ketoconazole?
MediHelp also lists interactions of Ketoconazole with, for example, Alfuzosin, Alprazolam, Avanafil. The full list is on the Ketoconazole page.
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