Drug interactions
Digoxin + Nirmatrelvir
Severity: Moderate
Digoxin and Nirmatrelvir: 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
Nirmatrelvir given with ritonavir inhibits P-glycoprotein and can increase digoxin levels. This can lead to digoxin toxicity including arrhythmias.
What this interaction means in plain words
Digoxin and Nirmatrelvir 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; Nirmatrelvir belongs to Anti Virals.
Why it happens
Inhibition of P-glycoprotein increases digoxin absorption and decreases its renal and intestinal elimination.
What to do
Measure digoxin concentration before starting the combination and consider reducing the digoxin dose. Monitor levels and toxicity symptoms during and after the course.
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
Other interactions of Nirmatrelvir
- Alfuzosin + Nirmatrelvir Contraindicated
- Amiodarone + Nirmatrelvir Contraindicated
- Apalutamide + Nirmatrelvir Contraindicated
- Carbamazepine + Nirmatrelvir Contraindicated
- Colchicine + Nirmatrelvir Contraindicated
- Dronedarone + Nirmatrelvir Contraindicated
Frequently asked questions
Can I take Digoxin with Nirmatrelvir?
MediHelp rates the interaction as moderate. Digoxin and Nirmatrelvir 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. Nirmatrelvir given with ritonavir inhibits P-glycoprotein and can increase digoxin levels. This can lead to digoxin toxicity including arrhythmias.
How serious is the interaction between Digoxin and Nirmatrelvir?
MediHelp rates it moderate, 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 the combination and consider reducing the digoxin dose. Monitor levels and toxicity symptoms during and after the course.
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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