Drug interactions
Digoxin + Nirmatrelvir / ritonavir
Severity: Moderate
Digoxin and Nirmatrelvir / ritonavir: 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
Ritonavir and nirmatrelvir inhibit P-glycoprotein, which can raise digoxin concentrations. Patients may develop digoxin toxicity, including nausea, visual changes and arrhythmias.
What this interaction means in plain words
Digoxin and Nirmatrelvir / ritonavir 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.
Why it happens
P-glycoprotein inhibition by ritonavir and nirmatrelvir increases digoxin absorption and reduces its clearance.
What to do
Check a baseline digoxin level and reduce the dose or extend the interval during the five-day course. Monitor digoxin levels and for toxicity, especially with renal impairment.
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 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 Nirmatrelvir / ritonavir?
MediHelp rates the interaction as moderate. Digoxin and Nirmatrelvir / ritonavir 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. Ritonavir and nirmatrelvir inhibit P-glycoprotein, which can raise digoxin concentrations. Patients may develop digoxin toxicity, including nausea, visual changes and arrhythmias.
How serious is the interaction between Digoxin and Nirmatrelvir / ritonavir?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Check a baseline digoxin level and reduce the dose or extend the interval during the five-day course. Monitor digoxin levels and for toxicity, especially with renal impairment.
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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