Drug interactions
Digoxin + Ritonavir
Severity: Major
Digoxin and Ritonavir: 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
Ritonavir can increase digoxin concentrations substantially, raising the risk of digoxin toxicity such as arrhythmias, nausea and visual disturbance. Digoxin has a narrow therapeutic index, so even moderate increases matter.
What this interaction means in plain words
Digoxin and Ritonavir 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.
Digoxin belongs to Cardiovascular; Ritonavir belongs to Anti Virals.
Why it happens
Ritonavir inhibits P-glycoprotein, reducing digoxin renal tubular secretion and increasing absorption.
What to do
Consider reducing the digoxin dose when starting ritonavir and monitor digoxin concentrations, ECG and renal function. Titrate to clinical response.
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
Other interactions of Ritonavir
- Alfuzosin + Ritonavir Contraindicated
- Amiodarone + Ritonavir Contraindicated
- Avanafil + Ritonavir Contraindicated
- Colchicine + Ritonavir Contraindicated
- Dronedarone + Ritonavir Contraindicated
- Eletriptan + Ritonavir Contraindicated
Frequently asked questions
Can I take Digoxin with Ritonavir?
MediHelp rates the interaction as major. Digoxin and Ritonavir 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. Ritonavir can increase digoxin concentrations substantially, raising the risk of digoxin toxicity such as arrhythmias, nausea and visual disturbance. Digoxin has a narrow therapeutic index, so even moderate increases matter.
How serious is the interaction between Digoxin and Ritonavir?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Consider reducing the digoxin dose when starting ritonavir and monitor digoxin concentrations, ECG and renal function. Titrate to clinical response.
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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