Wechselwirkungen von Digoxin

Reserve the combination of amiodarone with other antiarrhythmic therapies that prolong the QTc to patients with life-threatening ventricular arrhythmias who are incompletely responsive to a single agent. (Fachinformation zu Amiodaron, Warnhinweise und Vorsichtsmaßnahmen)

The use of SAPHRIS should be avoided in combination with other drugs known to prolong QTc including Class 1A antiarrhythmics (e.g., quinidine, procainamide) or Class 3 antiarrhythmics (e.g., amiodarone, sotalol), antipsychotic medications (e.g., ziprasidone, chlorpromazine, thioridazine), and antibiotics (e.g., gatifloxacin, moxifloxacin). (Fachinformation zu Asenapin, Warnhinweise und Vorsichtsmaßnahmen)

Drug Class Drugs within class that are contraindicated with REYATAZ Alpha 1-adrenoreceptor antagonist Alfuzosin Anticonvulsants Carbamazepine, phenobarbital, phenytoin Antiarrhythmics Amiodarone (with ritonavir), quinidine (with ritonavir) Antimycobacterials Rifampin Antineoplastics Apalutamide, encorafenib, irinotecan, ivosidenib Antipsychotics Lurasidone (with… (Fachinformation zu Atazanavir, Gegenanzeigen)

• Arrhythmias with Concomitant Digoxin Use: Avoid use of Calcium Chloride Injection in patients receiving digoxin. (Fachinformation zu Calciumchlorid, Warnhinweise und Vorsichtsmaßnahmen)

Administration of Calcium Gluconate Injection should be avoided in patients receiving cardiac glycosides. (Fachinformation zu Calciumgluconat, Warnhinweise und Vorsichtsmaßnahmen)

Proarrhythmic effects Like many other drugs (including all other Class Ia antiarrhythmics), quinidine prolongs the QT c interval, and this can lead to torsades de pointes , a life-threatening ventricular arrhythmia (see OVERDOSAGE ). (Fachinformation zu Chinidin, Warnhinweise)

Some patients have shown clinical signs consistent with digoxin toxicity, including potentially fatal arrhythmias. (Fachinformation zu Clarithromycin, Arzneimittelwechselwirkungen)

Considering the known proarrhythmic properties of Norpace or Norpace CR and the lack of evidence of improved survival for any antiarrhythmic drug in patients without life-threatening arrhythmias, the use of Norpace or Norpace CR as well as other antiarrhythmic agents should be reserved for patients with life-threatening ventricular arrhythmias. (Fachinformation zu Disopyramid, Boxed Warning (umrahmter Warnhinweis))

NA – Not available/reported 7.3 Pharmacodynamic Drug Interactions Antiarrhythmics Dofetilide Concomitant administration with digoxin was associated with a higher rate of torsades de pointes . (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Digoxin In the ANDROMEDA (patients with recently decompensated heart failure) and PALLAS (patients with permanent AF) trials baseline use of digoxin was associated with an increased risk of arrhythmic or sudden death in dronedarone-treated patients compared to placebo. (Fachinformation zu Dronedaron, Arzneimittelwechselwirkungen)

Table 2: Oral drugs that can be administered concomitantly with Ferric Citrate Tablets Amlodipine Aspirin Atorvastatin Calcitriol Clopidogrel Digoxin Diltiazem Doxercalciferol Enalapril Fluvastatin Glimepiride Levofloxacin Losartan Metoprolol Pravastatin Propranolol Sitagliptin Warfarin Oral drugs that have to be separated from Ferric Citrate Tablets and meals… (Fachinformation zu Eisen(III)-citrat, Arzneimittelwechselwirkungen)

These generally have fallen into two categories: (1) patients with severe myocardial disease who have been receiving digitalis and presumably developed acute hypokalemia with fatal arrhythmia; (2) patients with severely decompensated hepatic cirrhosis with ascites, with or without accompanying encephalopathy, who were in electrolyte imbalance and died because… (Fachinformation zu Etacrynsäure, Warnhinweise)

Concomitant negative chronotropic therapy such as digoxin or beta-blockers may lower the risk of this complication. (Fachinformation zu Flecainid, Boxed Warning (umrahmter Warnhinweis))

Fosamprenavir calcium is contraindicated when coadministered with the following drugs: Alpha 1-adrenoreceptor antagonist: Alfuzosin Antiarrhythmics: Flecainide (with ritonavir ), propafenone (with ritonavir ) Antimycobacterial: Rifampin Antipsychotic: Lurasidone (with ritonavir ), pimozide Ergot derivatives: Dihydroergotamine, ergonovine, ergotamine, methylergonovine… (Fachinformation zu Fosamprenavir, Gegenanzeigen)

Avoid co-administration of CONTEPO with drugs known to prolong the QT interval, such as class IA or class III antiarrhythmic medications, tricyclic antidepressants, macrolides, and antipsychotics [see Warnings and Precautions ( 5.2 )] . (Fachinformation zu Fosfomycin, Arzneimittelwechselwirkungen)

Antiarrhythmics Disopyramide Dofetilide Dronedarone Quinidine Contraindicated during and 2 weeks after TOLSURA treatment. (Fachinformation zu Itraconazol, Arzneimittelwechselwirkungen)

Johanniskraut kann diese Arzneimittel abschwächen, indem es ihren Abbau beschleunigt, was Organabstoßung, Blutgerinnsel oder Wirkverlust bedeuten kann. (NCCIH, St. John's Wort)

These conditions include patients with hypokalemia or hypomagnesemia, with congenital long QT syndrome, patients taking antiarrhythmic medicines or other medicinal products with known risk for QT prolongation/ Torsades de Pointes, and cumulative high-dose anthracycline therapy. (Fachinformation zu Lapatinib, Warnhinweise und Vorsichtsmaßnahmen)

Coadministration of amiodarone with ledipasvir and sofosbuvir is not recommended; if coadministration is required, cardiac monitoring is recommended [see Warnings and Precautions (5.2) , Adverse Reactions (6.2) ]. digoxin ↑ digoxin Coadministration of ledipasvir and sofosbuvir with digoxin may increase the concentration of digoxin. (Fachinformation zu Ledipasvir und Sofosbuvir, Arzneimittelwechselwirkungen)

Alpha 1- Adrenoreceptor Antagonist: alfuzosin Antianginal: ranolazine Antiarrhythmic: dronedarone Anti-gout: colchicine Antipsychotics: lurasidone, pimozide Ergot Derivatives: dihydroergotamine, ergotamine, methylergonovine GI Motility Agent: cisapride Hepatitis C direct acting antiviral: elbasvir/grazoprevir HMG-CoA Reductase Inhibitors: lovastatin, simvastatin… (Fachinformation zu Lopinavir und Ritonavir, Gegenanzeigen)

Considering the known proarrhythmic properties of mexiletine and the lack of evidence of improved survival for any antiarrhythmic drug in patients without life-threatening arrhythmias, the use of mexiletine as well as other antiarrhythmic agents should be reserved for patients with life-threatening ventricular arrhythmia. (Fachinformation zu Mexiletin, Boxed Warning (umrahmter Warnhinweis))

Avoid co-administration of milnacipran hydrochloride and intravenous digoxin [see Warnings and Precautions ( 5.3 , 5.4 )] . (Fachinformation zu Milnacipran, Arzneimittelwechselwirkungen)

Therefore, moxifloxacin should be avoided with Class IA and Class III antiarrhythmics [see Warnings and Precautions ( 5.6 ), Nonclinical Toxicology ( 13.2 ), and Patient Counseling Information ( 17 )]. (Fachinformation zu Moxifloxacin, Arzneimittelwechselwirkungen)

Since there have been isolated reports of patients with elevated digoxin levels, and there is a possible interaction between digoxin and nifedipine extended-release tablet, it is recommended that digoxin levels be monitored when initiating, adjusting and discontinuing nifedipine extended-release tablet to avoid possible over- or under-digitalization. (Fachinformation zu Nifedipin, Arzneimittelwechselwirkungen)

…concentrations are associated with serious and/or life-threatening reactions [see Drug Interactions (7.3) ] : • Alpha 1-adrenoreceptor antagonist: alfuzosin • Antianginal: ranolazine • Antiarrhythmic: amiodarone, dronedarone, flecainide, propafenone, quinidine • Anti-gout: colchicine (in patients with renal and/or hepatic impairment [see Table 2 , Drug Interactions… (Fachinformation zu Nirmatrelvir und Ritonavir, Gegenanzeigen)

Considering the known proarrhythmic properties of procainamide and the lack of evidence of improved survival for any antiarrhythmic drug in patients without life-threatening arrhythmias, the use of procainamide as well as other antiarrhythmic agents should be reserved for patients with life-threatening ventricular arrhythmias. (Fachinformation zu Procainamid, Boxed Warning (umrahmter Warnhinweis))

• The applicability of the CAST results to other populations (e.g., those without recent myocardial infarction) or other antiarrhythmic drugs is uncertain, but at present, it is prudent to consider any IC antiarrhythmic to have a significant proarrhythmic risk in patients with structural heart disease. (Fachinformation zu Propafenon, Boxed Warning (umrahmter Warnhinweis))

WARNING: DRUG-DRUG INTERACTIONS LEADING TO POTENTIALLY SERIOUS AND/OR LIFE THREATENING REACTIONS Co-administration of NORVIR with several classes of drugs including sedative hypnotics, antiarrhythmics, or ergot alkaloid preparations may result in potentially serious and/or life-threatening adverse events due to possible effects of NORVIR on the hepatic metabolism… (Fachinformation zu Ritonavir, Boxed Warning (umrahmter Warnhinweis))

Coadministration of amiodarone with VOSEVI is not recommended; if coadministration is required, cardiac monitoring is recommended [see Warnings and Precautions (5.3) ]. digoxin ↑ digoxin Therapeutic concentration monitoring of digoxin is recommended when coadministered with VOSEVI. (Fachinformation zu Sofosbuvir und Velpatasvir, Arzneimittelwechselwirkungen)

Thiazide-induced electrolyte disturbances, i.e. hypokalemia, hypomagnesemia, increase the risk of digoxin toxicity, which may lead to fatal arrhythmic events (see Precautions ). (Fachinformation zu Spironolacton und Hydrochlorothiazid, Arzneimittelwechselwirkungen)

QT Prolongation : Patients with congenital QT syndrome or taking class IA or III antiarrhythmics should avoid using vardenafil hydrochloride tablets. (Fachinformation zu Vardenafil, Warnhinweise und Vorsichtsmaßnahmen)

Digoxin Concentrations Decreased Acarbose, Activated Charcoal, Albuterol, Antacids, certain cancer chemotherapy or radiation therapy, Cholestyramine, Colestipol, Exenatide, Kaolin-pectin, Meals High in Bran, Metoclopramide, Miglitol, Neomycin, Penicillamine, Phenytoin, Rifampin, St. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Beta-adrenergic Blockers and Calcium Channel Blockers Additive effects on AV node conduction can result in complete heart block. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

…to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude is Unclear Alprazolam, Azithromycin, Cyclosporine, Diclofenac, Diphenoxylate, Epoprostenol, Esomeprazole, Ibuprofen, Ketoconazole, Lansoprazole, Metformin, Omeprazole Measure serum digoxin concentrations before initiating concomitant drugs. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

…Saquinavir 27% 49% Spironolactone 25% NA Telmisartan 20 to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude is Unclear Alprazolam, Azithromycin, Cyclosporine, Diclofenac, Diphenoxylate, Epoprostenol, Esomeprazole, Ibuprofen, Ketoconazole, Lansoprazole, Metformin, Omeprazole Measure serum digoxin concentrations… (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Beta-adrenergic Blockers and Calcium Channel Blockers Additive effects on AV node conduction can result in complete heart block. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Beta-adrenergic Blockers and Calcium Channel Blockers Additive effects on AV node conduction can result in complete heart block. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Beta-adrenergic Blockers and Calcium Channel Blockers Additive effects on AV node conduction can result in complete heart block. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Beta-adrenergic Blockers and Calcium Channel Blockers Additive effects on AV node conduction can result in complete heart block. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Beta-adrenergic Blockers and Calcium Channel Blockers Additive effects on AV node conduction can result in complete heart block. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Digitalis Glycosides Concurrent use may induce hypokalemia and may potentiate digitalis toxicity. (Fachinformation zu Amphotericin B, Arzneimittelwechselwirkungen)

Digoxin Concentrations Decreased Acarbose, Activated Charcoal, Albuterol, Antacids, certain cancer chemotherapy or radiation therapy, Cholestyramine, Colestipol, Exenatide, Kaolin-pectin, Meals High in Bran, Metoclopramide, Miglitol, Neomycin, Penicillamine, Phenytoin, Rifampin, St. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Beta-adrenergic Blockers and Calcium Channel Blockers Additive effects on AV node conduction can result in complete heart block. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

• Digoxin: May increase digoxin plasma levels; monitor patients appropriately ( 7.3 ). (Fachinformation zu Atorvastatin, Arzneimittelwechselwirkungen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

…Spironolactone 25% NA Telmisartan 20 to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude is Unclear Alprazolam, Azithromycin, Cyclosporine, Diclofenac, Diphenoxylate, Epoprostenol, Esomeprazole, Ibuprofen, Ketoconazole, Lansoprazole, Metformin, Omeprazole Measure serum digoxin concentrations… (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Beta-adrenergic Blockers and Calcium Channel Blockers Additive effects on AV node conduction can result in complete heart block. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Table 4 Drug Interactions with BIXLENVO Concomitant Drug Class: Drug Name Effect on Concentration ↑ = Increase, ↓ = Decrease Clinical Comment Antiarrhythmics: digoxin dofetilide ↑ digoxin ↑ dofetilide Use digoxin with caution and monitor digoxin therapeutic concentration. (Fachinformation zu Bictegravir, Emtricitabin und Tenofoviralafenamid, Arzneimittelwechselwirkungen)

Beta-adrenergic Blockers and Calcium Channel Blockers Additive effects on AV node conduction can result in complete heart block. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Antihypertensives/Cardiac Glycosides Because brimonidine tartrate ophthalmic solution 0.1% and 0.15% may reduce blood pressure, caution in using drugs such as antihypertensives and/or cardiac glycosides with brimonidine tartrate ophthalmic solution 0.1% and 0.15% is advised. (Fachinformation zu Brimonidin, Arzneimittelwechselwirkungen)

Beta-adrenergic Blockers and Calcium Channel Blockers Additive effects on AV node conduction can result in complete heart block. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

…in clinical decisions when prescribing BELBUCA to patients with risk factors such as hypokalemia, bradycardia, recent conversion from atrial fibrillation, congestive heart failure, digitalis therapy, baseline QT prolongation, subclinical long-QT syndrome, or severe hypomagnesemia [see Dosage and Administration (2.4) , Adverse Reactions (6.1) , Clinical Pharmacology… (Fachinformation zu Buprenorphin, Warnhinweise und Vorsichtsmaßnahmen)

Consider these observations in clinical decisions when prescribing buprenorphine and naloxone sublingual tablets to patients with risk factors such as hypokalemia, bradycardia, recent conversion from atrial fibrillation, congestive heart failure, digitalis therapy, baseline QT prolongation, subclinical long-QT syndrome, or severe hypomagnesemia. (Fachinformation zu Buprenorphin und Naloxon, Warnhinweise und Vorsichtsmaßnahmen)

Drugs Metabolized by CYP2D6: Bupropion inhibits CYP2D6 and can increase concentrations of: antidepressants (e.g., venlafaxine, nortriptyline, imipramine, desipramine, paroxetine, fluoxetine, sertraline), antipsychotics (e.g., haloperidol, risperidone, thioridazine), beta-blockers (e.g., metoprolol), and Type 1C antiarrhythmics (e.g., propafenone, flecainide). (Fachinformation zu Bupropion, Arzneimittelwechselwirkungen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Digitalis Calcitriol dosage must be determined with care in patients undergoing treatment with digitalis, as hypercalcemia in such patients may precipitate cardiac arrhythmias (see PRECAUTIONS: General ). (Fachinformation zu Calcitriol, Arzneimittelwechselwirkungen)

Hypercalcemia may aggravate digitalis toxicity. (Fachinformation zu Calciumacetat, Warnhinweise und Vorsichtsmaßnahmen)

Digoxin Clinical Impact: Canagliflozin increases digoxin exposure [see Clinical Pharmacology (12.3) ] . (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Increases in exposure of other orally administered P‑gp substrates (e.g., sirolimus, tacrolimus, digoxin) may be observed when concomitantly used with EPIDIOLEX. (Fachinformation zu Cannabidiol (verschreibungspflichtig), Arzneimittelwechselwirkungen)

Carvedilol 16% 14% Conivaptan 33% 43% Diltiazem 20% NA Indomethacin 40% NA Mirabegron 29% 27% Nefazodone 27% 15% Nifedipine 45% NA Propantheline 24% 24% Quinine NA 33% Rabeprazole 29% 19% Saquinavir 27% 49% Spironolactone 25% NA Telmisartan 20 to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude… (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Digoxin Clinical Impact: The concomitant use of Celecoxib with digoxin has been reported to increase the serum concentration and prolong the half-life of digoxin. (Fachinformation zu Celecoxib, Arzneimittelwechselwirkungen)

Carvedilol 16% 14% Conivaptan 33% 43% Diltiazem 20% NA Indomethacin 40% NA Mirabegron 29% 27% Nefazodone 27% 15% Nifedipine 45% NA Propantheline 24% 24% Quinine NA 33% Rabeprazole 29% 19% Saquinavir 27% 49% Spironolactone 25% NA Telmisartan 20 to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude… (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

…25% NA Telmisartan 20 to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude is Unclear Alprazolam, Azithromycin, Cyclosporine, Diclofenac, Diphenoxylate, Epoprostenol, Esomeprazole, Ibuprofen, Ketoconazole, Lansoprazole, Metformin, Omeprazole Measure serum digoxin concentrations before initiating… (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

…syndrome, uncorrected electrolyte imbalance, such as hypokalemia or hypomagnesemia and cardiac disease, such as heart failure, myocardial infarction, or bradycardia), and patients receiving Class IA antiarrhythmic agents (quinidine, procainamide), or Class III antiarrhythmic agents (amiodarone, sotalol), tricyclic antidepressants, macrolides, and antipsychotics. (Fachinformation zu Ciprofloxacin, Warnhinweise und Vorsichtsmaßnahmen)

Such drugs include Class 1A (e.g., quinidine, procainamide) or Class III (e.g., amiodarone, sotalol) antiarrhythmic medications, antipsychotic medications (e.g., chlorpromazine, thioridazine), antibiotics (e.g., gatifloxacin, moxifloxacin), or any other class of medications known to prolong the QTc interval (e.g., pentamidine, levomethadyl acetate, methadone). (Fachinformation zu Citalopram, Warnhinweise und Vorsichtsmaßnahmen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Because clomipramine hydrochloride capsules are highly bound to serum protein, the administration of clomipramine hydrochloride capsules to patients taking other drugs that are highly bound to protein (e.g., warfarin, digoxin) may cause an increase in plasma concentrations of these drugs, potentially resulting in adverse effects. (Fachinformation zu Clomipramin, Arzneimittelwechselwirkungen)

Drugs that affect sinus node function or AV node conduction (e.g., digitalis, calcium channel blockers, beta blockers) Clinical Implication Concomitant use of drugs that affect sinus node function or AV node conduction with clonidine potentiate bradycardia and risk of AV block [see Warnings and Precautions (5.1) ]. (Fachinformation zu Clonidin, Arzneimittelwechselwirkungen)

…droperidol, pimozide), specific antibiotics (e.g., erythromycin, gatifloxacin, moxifloxacin, sparfloxacin), Class 1A antiarrhythmic medications (e.g., quinidine, procainamide) or Class III antiarrhythmics (e.g., amiodarone, sotalol), and others (e.g., pentamidine, levomethadyl acetate, methadone, halofantrine, mefloquine, dolasetron mesylate, probucol or tacrolimus). (Fachinformation zu Clozapin, Warnhinweise und Vorsichtsmaßnahmen)

Digoxin Concentrations Decreased Acarbose, Activated Charcoal, Albuterol, Antacids, certain cancer chemotherapy or radiation therapy, Cholestyramine, Colestipol, Exenatide, Kaolin-pectin, Meals High in Bran, Metoclopramide, Miglitol, Neomycin, Penicillamine, Phenytoin, Rifampin, St. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Digoxin Concentrations Decreased Acarbose, Activated Charcoal, Albuterol, Antacids, certain cancer chemotherapy or radiation therapy, Cholestyramine, Colestipol, Exenatide, Kaolin-pectin, Meals High in Bran, Metoclopramide, Miglitol, Neomycin, Penicillamine, Phenytoin, Rifampin, St. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Drug Interactions Reversible decreases in steady-state plasma digoxin concentrations and renal glycoside excretion were observed in patients receiving beta-acetyldigoxin and chemotherapy regimens containing cyclophosphamide, vincristine and prednisone with or without cytarabine injection or procarbazine. (Fachinformation zu Cytarabin, Arzneimittelwechselwirkungen)

…mg ↔ ↔ Bumetanide (1 mg) 10 mg once daily for 7 days ↑13% [↓2%, ↑31%] ↑13% [↓1%, ↑30%] Valsartan (320 mg) 20 mg ↓6% [↓24%, ↑16%] ↑5% [↓15%, ↑29%] Simvastatin (40 mg) 20 mg ↔ ↑19% Digoxin (0.25 mg) 20 mg loading dose then 10 mg once daily for 7 days ↔ ↔ Warfarin (25 mg) 20 mg loading dose then 10 mg once daily for 7 days ↔ ↔ ↔ = no change (geometric mean ratio… (Fachinformation zu Dapagliflozin, Arzneimittelwechselwirkungen)

…to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude is Unclear Alprazolam, Azithromycin, Cyclosporine, Diclofenac, Diphenoxylate, Epoprostenol, Esomeprazole, Ibuprofen, Ketoconazole, Lansoprazole, Metformin, Omeprazole Measure serum digoxin concentrations before initiating concomitant drugs. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Routine therapeutic drug monitoring for digoxin should be continued [see Clinical Pharmacology (12.3)] . (Fachinformation zu Darifenacin, Arzneimittelwechselwirkungen)

The serum digoxin concentrations should be monitored and used for titration of digoxin dose to obtain the desired clinical effect. (Fachinformation zu Darunavir, Arzneimittelwechselwirkungen)

Other antiarrhythmics e.g. amiodarone, disopyramide, flecainide, lidocaine (systemic), mexiletine, propafenone, quinidine ↑ antiarrhythmics Clinical monitoring is recommended upon co-administration with antiarrhythmics. digoxin ↑ digoxin When co-administering with digoxin, titrate the digoxin dose and monitor digoxin concentrations. (Fachinformation zu Darunavir und Cobicistat, Arzneimittelwechselwirkungen)

QT Prolongation PHYRAGO may increase the risk of prolongation of QTc in patients including those with hypokalemia or hypomagnesemia, patients with congenital long QT syndrome, patients taking antiarrhythmic medicines or other medicinal products that lead to QT prolongation, and cumulative high-dose anthracycline therapy [see Adverse Reactions ( 6.1 )] . (Fachinformation zu Dasatinib, Warnhinweise und Vorsichtsmaßnahmen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

For patients expected to be on prolonged treatment or who take PPIs with medications such as digoxin or drugs that may cause hypomagnesemia (e.g., diuretics), health care professionals may consider monitoring magnesium levels prior to initiation of PPI treatment and periodically [see Adverse Reactions (6.2) ] . (Fachinformation zu Dexlansoprazol, Warnhinweise und Vorsichtsmaßnahmen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Digoxin: Increased digoxin substrate plasma concentration may occur. (Fachinformation zu Dextromethorphan und Chinidin, Arzneimittelwechselwirkungen)

…Telmisartan 20 to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude is Unclear Alprazolam, Azithromycin, Cyclosporine, Diclofenac, Diphenoxylate, Epoprostenol, Esomeprazole, Ibuprofen, Ketoconazole, Lansoprazole, Metformin, Omeprazole Measure serum digoxin concentrations before initiating concomitant… (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

…Telmisartan 20 to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude is Unclear Alprazolam, Azithromycin, Cyclosporine, Diclofenac, Diphenoxylate, Epoprostenol, Esomeprazole, Ibuprofen, Ketoconazole, Lansoprazole, Metformin, Omeprazole Measure serum digoxin concentrations before initiating concomitant… (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Effect on Absorption of Other Drugs Anticholinergic agents may affect gastrointestinal absorption of various drugs by affecting on gastrointestinal motility, such as slowly dissolving dosage forms of digoxin; increased serum digoxin concentration may result. (Fachinformation zu Dicycloverin, Arzneimittelwechselwirkungen)

Carvedilol 16% 14% Conivaptan 33% 43% Diltiazem 20% NA Indomethacin 40% NA Mirabegron 29% 27% Nefazodone 27% 15% Nifedipine 45% NA Propantheline 24% 24% Quinine NA 33% Rabeprazole 29% 19% Saquinavir 27% 49% Spironolactone 25% NA Telmisartan 20 to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude… (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

…to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude is Unclear Alprazolam, Azithromycin, Cyclosporine, Diclofenac, Diphenoxylate, Epoprostenol, Esomeprazole, Ibuprofen, Ketoconazole, Lansoprazole, Metformin, Omeprazole Measure serum digoxin concentrations before initiating concomitant drugs. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Beta-adrenergic Blockers and Calcium Channel Blockers Additive effects on AV node conduction can result in complete heart block. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Digitalis Toxicity: Hypercalcemia increases the risk of digitalis toxicity. (Fachinformation zu Doxercalciferol, Warnhinweise und Vorsichtsmaßnahmen)

…development of prolonged QT syndrome, such as: 1) clinically significant bradycardia (less than 50 bpm), 2) any clinically significant cardiac disease, 3) treatment with Class I and Class III antiarrhythmics, 4) treatment with monoamine oxidase inhibitors (MAOI's), 5) concomitant treatment with other drug products known to prolong the QT interval (see PRECAUTIONS,… (Fachinformation zu Droperidol, Warnhinweise)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Digoxin Dutasteride capsules do not alter the steady-state pharmacokinetics of digoxin when administered concomitantly at a dose of 0.5 mg/day for 3 weeks [see Clinical Pharmacology (12.3) ]. (Fachinformation zu Dutasterid, Arzneimittelwechselwirkungen)

Tamsulosin Dosage adjustments are not necessary when tamsulosin is administered concomitantly with digoxin or theophylline [see Clinical Pharmacology (12.3) ]. (Fachinformation zu Dutasterid und Tamsulosin, Arzneimittelwechselwirkungen)

Transporters Concomitant use of ivacaftor or tezacaftor/ivacaftor with digoxin, a sensitive P-gp substrate, increased digoxin AUC by 1.3-fold, consistent with weak inhibition of P-gp by ivacaftor. (Fachinformation zu Elexacaftor, Tezacaftor und Ivacaftor, Arzneimittelwechselwirkungen)

Antiarrhythmics: e.g., amiodarone bepridil digoxin Indicates that a drug-drug interaction trial was conducted. disopyramide flecainide systemic lidocaine mexiletine propafenone quinidine ↑ antiarrhythmics ↑ digoxin Caution is warranted and therapeutic concentration monitoring, if available, is recommended for antiarrhythmics when coadministered with GENVOYA. (Fachinformation zu Elvitegravir, Cobicistat, Emtricitabin und Tenofovir, Arzneimittelwechselwirkungen)

…to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude is Unclear Alprazolam, Azithromycin, Cyclosporine, Diclofenac, Diphenoxylate, Epoprostenol, Esomeprazole, Ibuprofen, Ketoconazole, Lansoprazole, Metformin, Omeprazole Measure serum digoxin concentrations before initiating concomitant drugs. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

…to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude is Unclear Alprazolam, Azithromycin, Cyclosporine, Diclofenac, Diphenoxylate, Epoprostenol, Esomeprazole, Ibuprofen, Ketoconazole, Lansoprazole, Metformin, Omeprazole Measure serum digoxin concentrations before initiating concomitant drugs. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

ECG monitoring is recommended if therapy is initiated in patients with congestive heart failure, bradyarrhythmias, drugs known to prolong the QT interval, including Class Ia and III antiarrhythmics, and electrolyte abnormalities. (Fachinformation zu Eribulin, Warnhinweise und Vorsichtsmaßnahmen)

Erythromycin should be avoided in patients with known prolongation of the QT interval, patients with ongoing proarrhythmic conditions such as uncorrected hypokalemia or hypomagnesemia, clinically significant bradycardia, and in patients receiving Class IA (quinidine, procainamide) or Class III (dofetilide, amiodarone, sotalol) antiarrhythmic agents. (Fachinformation zu Erythromycin, Warnhinweise)

Beta-adrenergic Blockers and Calcium Channel Blockers Additive effects on AV node conduction can result in complete heart block. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

…to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude is Unclear Alprazolam, Azithromycin, Cyclosporine, Diclofenac, Diphenoxylate, Epoprostenol, Esomeprazole, Ibuprofen, Ketoconazole, Lansoprazole, Metformin, Omeprazole Measure serum digoxin concentrations before initiating concomitant drugs. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Cyclosporine, Digoxin, Methotrexate Etodolac, like other NSAIDs, through effects on renal prostaglandins, may cause changes in the elimination of these drugs leading to elevated serum levels of cyclosporine, digoxin, methotrexate, and increased toxicity. (Fachinformation zu Etodolac, Arzneimittelwechselwirkungen)

Other agents Antiarrhythmics : digoxin ↔ etravirine ↑ digoxin For patients who are initiating a combination of Etravirine and digoxin, the lowest dose of digoxin should initially be prescribed. (Fachinformation zu Etravirin, Arzneimittelwechselwirkungen)

Digoxin Concentrations Decreased Acarbose, Activated Charcoal, Albuterol, Antacids, certain cancer chemotherapy or radiation therapy, Cholestyramine, Colestipol, Exenatide, Kaolin-pectin, Meals High in Bran, Metoclopramide, Miglitol, Neomycin, Penicillamine, Phenytoin, Rifampin, St. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Digoxin : During VYTORIN initiation, monitor digoxin levels. (Fachinformation zu Ezetimib und Simvastatin, Arzneimittelwechselwirkungen)

Potential for Famciclovir to Affect Other Drugs The steady-state pharmacokinetics of digoxin were not altered by concomitant administration of multiple doses of famciclovir (500 mg three times daily). (Fachinformation zu Famciclovir, Arzneimittelwechselwirkungen)

Beta-adrenergic Blockers and Calcium Channel Blockers Additive effects on AV node conduction can result in complete heart block. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Digoxin Clinical Impact: The concomitant use of fenoprofen with digoxin has been reported to increase the serum concentration and prolong the half-life of digoxin. (Fachinformation zu Fenoprofen, Arzneimittelwechselwirkungen)

…as: 1) clinically significant bradycardia (less than 50 bpm), 2) any clinically significant cardiac disease, including baseline prolonged QT interval, 3) treatment with Class 1 and Class III antiarrhythmics, 4) treatment with monoamine oxidase inhibitors (MAOI's), 5) concomitant treatment with other drug products known to prolong the QT interval and 6) electrolyte… (Fachinformation zu Fentanyl, Warnhinweise und Vorsichtsmaßnahmen)

Digoxin or Other P-glycoprotein Substrates Examples Digoxin, sirolimus Clinical Implications The concomitant use of ADDYI with digoxin, a drug that is transported by P-glycoprotein (P-gp), increases the digoxin concentration [see Clinical Pharmacology (12.3) ] . (Fachinformation zu Flibanserin, Arzneimittelwechselwirkungen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Coadministration of fluoxetine with other drugs that are metabolized by CYP2D6, including certain antidepressants (e.g., TCAs), antipsychotics (e.g., phenothiazines and most atypicals), and antiarrhythmics (e.g., propafenone, flecainide, and others) should be approached with caution. (Fachinformation zu Fluoxetin, Arzneimittelwechselwirkungen)

Digoxin Clinical Impact: The concomitant use of flurbiprofen with digoxin has been reported to increase the serum concentration and prolong the half-life of digoxin [ see Clinical Pharmacology (12.3) ]. (Fachinformation zu Flurbiprofen, Arzneimittelwechselwirkungen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

…prolongation and the potential for torsades de pointes, the use of FOSCAVIR should be avoided in combination with agents known to prolong the QT interval including Class IA (e.g., quinidine or procainamide) or Class III (e.g., dofetilide, amiodarone, sotalol) antiarrhythmic agents, phenothiazines, tricyclic antidepressants, and certain macrolides and fluoroquinolones. (Fachinformation zu Foscarnet, Arzneimittelwechselwirkungen)

In separate single or multiple dose pharmacokinetic interaction studies with chlorthalidone, nifedipine, propranolol, hydrochlorothiazide, cimetidine, metoclopramide, propantheline, digoxin, and warfarin, the bioavailability of fosinoprilat was not altered by coadministration of fosinopril with any one of these drugs. (Fachinformation zu Fosinopril, Arzneimittelwechselwirkungen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

…concentration of amprenavir Calcium channel blockers Nifedipine, nimodipine, nisoldipine, verapamil Other Albendazole (decreases active metabolite), chlorpropamide, clozapine, cyclosporine, digoxin, disopyramide, folic acid, methadone, mexiletine, praziquantel, quetiapine 7.3 Hyperammonemia with Concomitant Use of Valproate Concomitant administration of phenytoin and valproate… (Fachinformation zu Fosphenytoin, Arzneimittelwechselwirkungen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

…to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude is Unclear Alprazolam, Azithromycin, Cyclosporine, Diclofenac, Diphenoxylate, Epoprostenol, Esomeprazole, Ibuprofen, Ketoconazole, Lansoprazole, Metformin, Omeprazole Measure serum digoxin concentrations before initiating concomitant drugs. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

…to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude is Unclear Alprazolam, Azithromycin, Cyclosporine, Diclofenac, Diphenoxylate, Epoprostenol, Esomeprazole, Ibuprofen, Ketoconazole, Lansoprazole, Metformin, Omeprazole Measure serum digoxin concentrations before initiating concomitant drugs. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Other Anticholinergic Drugs There is potential for an additive interaction between glycopyrrolate and concomitantly used anticholinergic drugs (e.g., tricyclic antidepressants, anti-epileptics, class I antiarrhythmics, anti­-spasmodics, amantadine) resulting in increased anticholinergic adverse reactions. (Fachinformation zu Glycopyrroniumbromid, Arzneimittelwechselwirkungen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

…to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude is Unclear Alprazolam, Azithromycin, Cyclosporine, Diclofenac, Diphenoxylate, Epoprostenol, Esomeprazole, Ibuprofen, Ketoconazole, Lansoprazole, Metformin, Omeprazole Measure serum digoxin concentrations before initiating concomitant drugs. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Digoxin Concomitant PLAQUENIL and digoxin therapy may result in increased serum digoxin levels. (Fachinformation zu Hydroxychloroquin, Arzneimittelwechselwirkungen)

…to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude is Unclear Alprazolam, Azithromycin, Cyclosporine, Diclofenac, Diphenoxylate, Epoprostenol, Esomeprazole, Ibuprofen, Ketoconazole, Lansoprazole, Metformin, Omeprazole Measure serum digoxin concentrations before initiating concomitant drugs. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

…to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude is Unclear Alprazolam, Azithromycin, Cyclosporine, Diclofenac, Diphenoxylate, Epoprostenol, Esomeprazole, Ibuprofen, Ketoconazole, Lansoprazole, Metformin, Omeprazole Measure serum digoxin concentrations before initiating concomitant drugs. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Digoxin: Supraventricular arrhythmias may mask the cardiotoxicity associated with excessive digoxin levels. (Fachinformation zu Ibutilid, Arzneimittelwechselwirkungen)

…FANAPT should be avoided in combination with other drugs that are known to prolong QTc including Class 1A (e.g., quinidine, procainamide) or Class III (e.g., amiodarone, sotalol) antiarrhythmic medications, antipsychotic medications (e.g., chlorpromazine, thioridazine), antibiotics (e.g., gatifloxacin, moxifloxacin), or any other class of medications known to… (Fachinformation zu Iloperidon, Warnhinweise und Vorsichtsmaßnahmen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Carvedilol 16% 14% Conivaptan 33% 43% Diltiazem 20% NA Indomethacin 40% NA Mirabegron 29% 27% Nefazodone 27% 15% Nifedipine 45% NA Propantheline 24% 24% Quinine NA 33% Rabeprazole 29% 19% Saquinavir 27% 49% Spironolactone 25% NA Telmisartan 20 to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude… (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Digoxin Concentrations Decreased Acarbose, Activated Charcoal, Albuterol, Antacids, certain cancer chemotherapy or radiation therapy, Cholestyramine, Colestipol, Exenatide, Kaolin-pectin, Meals High in Bran, Metoclopramide, Miglitol, Neomycin, Penicillamine, Phenytoin, Rifampin, St. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Beta-adrenergic Blockers and Calcium Channel Blockers Additive effects on AV node conduction can result in complete heart block. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Hyperpolarization-Activated Cyclic Nucleotide-Gated Channel Blocker Ivabradine can increase the risk of bradycardia. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Co-administration with digoxin, a sensitive P-gp substrate, increased digoxin exposure by 1.3-fold, consistent with weak inhibition of P-gp by ivacaftor. (Fachinformation zu Ivacaftor, Arzneimittelwechselwirkungen)

…to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude is Unclear Alprazolam, Azithromycin, Cyclosporine, Diclofenac, Diphenoxylate, Epoprostenol, Esomeprazole, Ibuprofen, Ketoconazole, Lansoprazole, Metformin, Omeprazole Measure serum digoxin concentrations before initiating concomitant drugs. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Warfarin, Digoxin, Salicylate, and Heparin The in vitro binding of warfarin to plasma proteins is only slightly reduced by ketorolac tromethamine (99.5% control vs 99.3%) when ketorolac plasma concentrations reach 5 to 10 mcg/mL. (Fachinformation zu Ketorolac, Arzneimittelwechselwirkungen)

Beta-adrenergic Blockers and Calcium Channel Blockers Additive effects on AV node conduction can result in complete heart block. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

…to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude is Unclear Alprazolam, Azithromycin, Cyclosporine, Diclofenac, Diphenoxylate, Epoprostenol, Esomeprazole, Ibuprofen, Ketoconazole, Lansoprazole, Metformin, Omeprazole Measure serum digoxin concentrations before initiating concomitant drugs. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Clinical Comment Antiarrhythmics: digoxin ↑ digoxin Use with caution and monitor digoxin therapeutic concentration. (Fachinformation zu Lenacapavir, Arzneimittelwechselwirkungen)

• Digoxin: Monitor digoxin plasma levels periodically due to increased C max and AUC with concomitant REVLIMID therapy ( 7.1 ). (Fachinformation zu Lenalidomid, Arzneimittelwechselwirkungen)

Digoxin Levetiracetam (1000 mg twice daily) did not influence the pharmacokinetics and pharmacodynamics (ECG) of digoxin given as a 0.25 mg dose every day. (Fachinformation zu Levetiracetam, Arzneimittelwechselwirkungen)

Levofloxacin should be avoided in patients with known prolongation of the QT interval, patients with uncorrected hypokalemia, and patients receiving Class IA (quinidine, procainamide), or Class III (amiodarone, sotalol) antiarrhythmic agents. (Fachinformation zu Levofloxacin, Warnhinweise und Vorsichtsmaßnahmen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Use in Thyroid Disorders and Hypermetabolic States Hypothyroidism may reduce the requirements for digoxin. (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Use in Thyroid Disorders and Hypermetabolic States Hypothyroidism may reduce the requirements for digoxin. (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

…to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude is Unclear Alprazolam, Azithromycin, Cyclosporine, Diclofenac, Diphenoxylate, Epoprostenol, Esomeprazole, Ibuprofen, Ketoconazole, Lansoprazole, Metformin, Omeprazole Measure serum digoxin concentrations before initiating concomitant drugs. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Use in Thyroid Disorders and Hypermetabolic States Hypothyroidism may reduce the requirements for digoxin. (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Coadministration of lomitapide with P-gp substrates (such as aliskiren, ambrisentan, colchicine, dabigatran etexilate, digoxin, everolimus, fexofenadine, imatinib, lapatinib, maraviroc, nilotinib, posaconazole, ranolazine, saxagliptin, sirolimus, sitagliptin, talinolol, tolvaptan, topotecan) may increase the absorption of P-gp substrates. (Fachinformation zu Lomitapid, Arzneimittelwechselwirkungen)

…combination with others drugs or herbal products that are known to prolong the QT interval, including Class 1A (e.g., quinidine, procainamide) or Class III (e.g., amiodarone, sotalol) antiarrhythmics, antipsychotics (e.g., chlorpromazine, haloperidol, thioridazine, ziprasidone), antibiotics (e.g., moxifloxacin), or any other drug known to prolong the QT interval… (Fachinformation zu Loperamid, Warnhinweise)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Digoxin Clinical Impact: The concomitant use of mefenamic acid with digoxin has been reported to increase the serum concentration and prolong the half-life of digoxin. (Fachinformation zu Mefenaminsäure, Arzneimittelwechselwirkungen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

…to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude is Unclear Alprazolam, Azithromycin, Cyclosporine, Diclofenac, Diphenoxylate, Epoprostenol, Esomeprazole, Ibuprofen, Ketoconazole, Lansoprazole, Metformin, Omeprazole Measure serum digoxin concentrations before initiating concomitant drugs. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Examples: Drugs known to have potential to prolong QT interval: Class I and III antiarrhythmics, some neuroleptics and tricyclic antidepressants, and calcium channel blockers. (Fachinformation zu Methadon, Arzneimittelwechselwirkungen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Digoxin Concentrations Decreased Acarbose, Activated Charcoal, Albuterol, Antacids, certain cancer chemotherapy or radiation therapy, Cholestyramine, Colestipol, Exenatide, Kaolin-pectin, Meals High in Bran, Metoclopramide, Miglitol, Neomycin, Penicillamine, Phenytoin, Rifampin, St. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Beta-adrenergic Blockers and Calcium Channel Blockers Additive effects on AV node conduction can result in complete heart block. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Digoxin Concentrations Decreased Acarbose, Activated Charcoal, Albuterol, Antacids, certain cancer chemotherapy or radiation therapy, Cholestyramine, Colestipol, Exenatide, Kaolin-pectin, Meals High in Bran, Metoclopramide, Miglitol, Neomycin, Penicillamine, Phenytoin, Rifampin, St. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Carvedilol 16% 14% Conivaptan 33% 43% Diltiazem 20% NA Indomethacin 40% NA Mirabegron 29% 27% Nefazodone 27% 15% Nifedipine 45% NA Propantheline 24% 24% Quinine NA 33% Rabeprazole 29% 19% Saquinavir 27% 49% Spironolactone 25% NA Telmisartan 20 to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude… (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Beta-adrenergic Blockers and Calcium Channel Blockers Additive effects on AV node conduction can result in complete heart block. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Digoxin: May decrease plasma digoxin levels. (Fachinformation zu Naltrexon und Bupropion, Arzneimittelwechselwirkungen)

Digoxin Clinical Impact: The concomitant use of naproxen with digoxin has been reported to increase the serum concentration and prolong the half-life of digoxin Intervention: During concomitant use of Naproxen Suspension and digoxin, monitor serum digoxin levels. (Fachinformation zu Naproxen, Arzneimittelwechselwirkungen)

…to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude is Unclear Alprazolam, Azithromycin, Cyclosporine, Diclofenac, Diphenoxylate, Epoprostenol, Esomeprazole, Ibuprofen, Ketoconazole, Lansoprazole, Metformin, Omeprazole Measure serum digoxin concentrations before initiating concomitant drugs. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Digoxin Concentrations Decreased Acarbose, Activated Charcoal, Albuterol, Antacids, certain cancer chemotherapy or radiation therapy, Cholestyramine, Colestipol, Exenatide, Kaolin-pectin, Meals High in Bran, Metoclopramide, Miglitol, Neomycin, Penicillamine, Phenytoin, Rifampin, St. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Beta-adrenergic Blockers and Calcium Channel Blockers Additive effects on AV node conduction can result in complete heart block. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Carvedilol 16% 14% Conivaptan 33% 43% Diltiazem 20% NA Indomethacin 40% NA Mirabegron 29% 27% Nefazodone 27% 15% Nifedipine 45% NA Propantheline 24% 24% Quinine NA 33% Rabeprazole 29% 19% Saquinavir 27% 49% Spironolactone 25% NA Telmisartan 20 to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude… (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Digoxin Concentrations Decreased Acarbose, Activated Charcoal, Albuterol, Antacids, certain cancer chemotherapy or radiation therapy, Cholestyramine, Colestipol, Exenatide, Kaolin-pectin, Meals High in Bran, Metoclopramide, Miglitol, Neomycin, Penicillamine, Phenytoin, Rifampin, St. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Antiarrhythmics: Amiodarone, disopyramide, lidocaine Plasma concentrations may be decreased. (Fachinformation zu Nevirapin, Arzneimittelwechselwirkungen)

Beta-adrenergic Blockers and Calcium Channel Blockers Additive effects on AV node conduction can result in complete heart block. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Beta-adrenergic Blockers and Calcium Channel Blockers Additive effects on AV node conduction can result in complete heart block. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Beta-adrenergic Blockers and Calcium Channel Blockers Additive effects on AV node conduction can result in complete heart block. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Digoxin: exposure may be decreased and assessment of clinical response to digoxin should be performed (‎ 7 ). (Fachinformation zu Octreotid, Arzneimittelwechselwirkungen)

Ofloxacin should be avoided in patients with known prolongation of the QT interval, patients with uncorrected hypokalemia, and patients receiving Class IA (quinidine, procainamide), or Class III (amiodarone, sotalol) antiarrhythmic agents. (Fachinformation zu Ofloxacin, Vorsichtsmaßnahmen)

Coadministration of fluoxetine with other drugs that are metabolized by CYP2D6, including certain antidepressants (e.g., TCAs), antipsychotics (e.g., phenothiazines and most atypicals), and antiarrhythmics (e.g., propafenone, flecainide, and others) should be approached with caution. (Fachinformation zu Olanzapin und Fluoxetin, Arzneimittelwechselwirkungen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

…to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude is Unclear Alprazolam, Azithromycin, Cyclosporine, Diclofenac, Diphenoxylate, Epoprostenol, Esomeprazole, Ibuprofen, Ketoconazole, Lansoprazole, Metformin, Omeprazole Measure serum digoxin concentrations before initiating concomitant drugs. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

…to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude is Unclear Alprazolam, Azithromycin, Cyclosporine, Diclofenac, Diphenoxylate, Epoprostenol, Esomeprazole, Ibuprofen, Ketoconazole, Lansoprazole, Metformin, Omeprazole Measure serum digoxin concentrations before initiating concomitant drugs. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Monitor electrocardiograms (ECG) in patients with congestive heart failure, bradyarrhythmias, and electrolyte abnormalities and in patients taking drugs known to prolong the QT interval, including Class Ia and III antiarrhythmics [see Drug Interactions (7.1)] . (Fachinformation zu Oxaliplatin, Warnhinweise und Vorsichtsmaßnahmen)

Digoxin Clinical Impact: The concomitant use of oxaprozin with digoxin has been reported to increase the serum concentration and prolong the half-life of digoxin. (Fachinformation zu Oxaprozin, Arzneimittelwechselwirkungen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

…paliperidone should be avoided in combination with other drugs that are known to prolong QTc including Class 1A (e.g., quinidine, procainamide) or Class III (e.g., amiodarone, sotalol) antiarrhythmic medications, antipsychotic medications (e.g., chlorpromazine, thioridazine), antibiotics (e.g., gatifloxacin, moxifloxacin), or any other class of medications known to… (Fachinformation zu Paliperidon, Warnhinweise und Vorsichtsmaßnahmen)

For patients expected to be on prolonged treatment or who take PPIs with medications such as digoxin or drugs that may cause hypomagnesemia (e.g., diuretics), health care professionals may consider monitoring magnesium levels prior to initiation of PPI treatment and periodically [see Adverse Reactions (6.2) ]. (Fachinformation zu Pantoprazol, Warnhinweise und Vorsichtsmaßnahmen)

…to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude is Unclear Alprazolam, Azithromycin, Cyclosporine, Diclofenac, Diphenoxylate, Epoprostenol, Esomeprazole, Ibuprofen, Ketoconazole, Lansoprazole, Metformin, Omeprazole Measure serum digoxin concentrations before initiating concomitant drugs. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Digitalis Toxicity: Risk increases with hypercalcemia. (Fachinformation zu Paricalcitol, Warnhinweise und Vorsichtsmaßnahmen)

Monitor patients who are at significant risk of developing QTc prolongation, including patients with a history of QT interval prolongation, in patients taking antiarrhythmics or other medications that may prolong QT interval, and those with relevant preexisting cardiac disease [see Drug Interactions (7.5)] . (Fachinformation zu Pazopanib, Warnhinweise und Vorsichtsmaßnahmen)

Digoxin Concentrations Decreased Acarbose, Activated Charcoal, Albuterol, Antacids, certain cancer chemotherapy or radiation therapy, Cholestyramine, Colestipol, Exenatide, Kaolin-pectin, Meals High in Bran, Metoclopramide, Miglitol, Neomycin, Penicillamine, Phenytoin, Rifampin, St. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Digoxin Concentrations Decreased Acarbose, Activated Charcoal, Albuterol, Antacids, certain cancer chemotherapy or radiation therapy, Cholestyramine, Colestipol, Exenatide, Kaolin-pectin, Meals High in Bran, Metoclopramide, Miglitol, Neomycin, Penicillamine, Phenytoin, Rifampin, St. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

The use of NUPLAZID should be avoided in patients with known QT prolongation or in combination with other drugs known to prolong QT interval including Class 1A antiarrhythmics (e.g., quinidine, procainamide) or Class 3 antiarrhythmics (e.g., amiodarone, sotalol), certain antipsychotic medications (e.g., ziprasidone, chlorpromazine, thioridazine), and certain… (Fachinformation zu Pimavanserin, Warnhinweise und Vorsichtsmaßnahmen)

DRUG INTERACTIONS Because pimozide prolongs the QT interval of the electrocardiogram, an additive effect on QT interval would be anticipated if administered with other drugs, such as phenothiazines, tricyclic antidepressants or antiarrhythmic agents, which prolong the QT interval. (Fachinformation zu Pimozid, Arzneimittelwechselwirkungen)

Beta-adrenergic Blockers and Calcium Channel Blockers Additive effects on AV node conduction can result in complete heart block. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

…to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude is Unclear Alprazolam, Azithromycin, Cyclosporine, Diclofenac, Diphenoxylate, Epoprostenol, Esomeprazole, Ibuprofen, Ketoconazole, Lansoprazole, Metformin, Omeprazole Measure serum digoxin concentrations before initiating concomitant drugs. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Digoxin: Concomitant use of Piroxicam Capsules can increase serum concentration and prolong half-life of digoxin. (Fachinformation zu Piroxicam, Arzneimittelwechselwirkungen)

Experience with PONVORY is limited in patients receiving concurrent therapy with drugs that decrease heart rate (e.g., beta-blockers, non-dihydropyridine calcium channel blockers - diltiazem and verapamil, and other drugs that may decrease heart rate such as digoxin). (Fachinformation zu Ponesimod, Warnhinweise und Vorsichtsmaßnahmen)

Digoxin Monitor digoxin plasma concentrations ( 7.2 ) (Fachinformation zu Posaconazol, Arzneimittelwechselwirkungen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

P-gp Substrates Refer to the Prescribing Information for a P-gp substrate where minimal concentration changes may lead to serious adverse reactions (e.g., digoxin and dabigatran) for the recommended dosage modification and/or monitoring. (Fachinformation zu Primaquin, Arzneimittelwechselwirkungen)

Beta-adrenergic Blockers and Calcium Channel Blockers Additive effects on AV node conduction can result in complete heart block. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Use in Thyroid Disorders and Hypermetabolic States Hypothyroidism may reduce the requirements for digoxin. (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Carvedilol 16% 14% Conivaptan 33% 43% Diltiazem 20% NA Indomethacin 40% NA Mirabegron 29% 27% Nefazodone 27% 15% Nifedipine 45% NA Propantheline 24% 24% Quinine NA 33% Rabeprazole 29% 19% Saquinavir 27% 49% Spironolactone 25% NA Telmisartan 20 to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude… (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Drugs transported by P-gp (e.g., digoxin), or drugs metabolized by CYP2D6 (e.g., tricyclic antidepressants) may need reduced doses when used with ASPRUZYO Sprinkle. (Fachinformation zu Ranolazin, Arzneimittelwechselwirkungen)

Digoxin Concentrations Decreased Acarbose, Activated Charcoal, Albuterol, Antacids, certain cancer chemotherapy or radiation therapy, Cholestyramine, Colestipol, Exenatide, Kaolin-pectin, Meals High in Bran, Metoclopramide, Miglitol, Neomycin, Penicillamine, Phenytoin, Rifampin, St. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

…itraconazole, ketoconazole Antipsychotics Haloperidol Barbiturates Phenobarbital Benzodiazepines Diazepam Beta-Blockers Propranolol Calcium Channel Blockers Diltiazem, nifedipine, verapamil Cardiac Glycoside Preparations Digoxin Corticosteroids Prednisone Fibrates Clofibrate Oral Hypoglycemics Sulfonylureas (e.g., glyburide, glipizide) Hormonal Contraceptives/Progestins… (Fachinformation zu Rifapentin, Arzneimittelwechselwirkungen)

P-gp Substrates with a Narrow Therapeutic Index (e.g. digoxin) Clinical Impact: Increased plasma concentrations of P-gp substrates (e.g., digoxin) may result in potential adverse reactions [see Clinical Pharmacology (12.3) ]. (Fachinformation zu Rolapitant, Arzneimittelwechselwirkungen)

…anesthetics or agents structurally related to amide- type local anesthetics, since the toxic effects of these drugs are additive. [See Drug Interactions 7.0 ] Patients treated with class III antiarrhythmic drugs (e.g., amiodarone) should be under close surveillance and ECG monitoring considered, since cardiac effects may be additive. [See Drug Interactions 7.0… (Fachinformation zu Ropivacain, Warnhinweise und Vorsichtsmaßnahmen)

Digoxin Concentrations Decreased Acarbose, Activated Charcoal, Albuterol, Antacids, certain cancer chemotherapy or radiation therapy, Cholestyramine, Colestipol, Exenatide, Kaolin-pectin, Meals High in Bran, Metoclopramide, Miglitol, Neomycin, Penicillamine, Phenytoin, Rifampin, St. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

…to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude is Unclear Alprazolam, Azithromycin, Cyclosporine, Diclofenac, Diphenoxylate, Epoprostenol, Esomeprazole, Ibuprofen, Ketoconazole, Lansoprazole, Metformin, Omeprazole Measure serum digoxin concentrations before initiating concomitant drugs. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Digoxin: During ZOCOR initiation, monitor digoxin levels. (Fachinformation zu Simvastatin, Arzneimittelwechselwirkungen)

…to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude is Unclear Alprazolam, Azithromycin, Cyclosporine, Diclofenac, Diphenoxylate, Epoprostenol, Esomeprazole, Ibuprofen, Ketoconazole, Lansoprazole, Metformin, Omeprazole Measure serum digoxin concentrations before initiating concomitant drugs. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Monitor electrolytes and electrocardiograms in patients with congestive heart failure, bradyarrhythmias, drugs known to prolong the QT interval, including Class Ia and III antiarrhythmics. (Fachinformation zu Sorafenib, Warnhinweise und Vorsichtsmaßnahmen)

Sotalol Proarrhythmic events were more common in patients receiving sotalol and digoxin than on either alone; it is not clear whether this represents an interaction or is related to the presence of CHF, a known risk factor for proarrhythmia, in patients receiving digoxin. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

…Conivaptan 33% 43% Diltiazem 20% NA Indomethacin 40% NA Mirabegron 29% 27% Nefazodone 27% 15% Nifedipine 45% NA Propantheline 24% 24% Quinine NA 33% Rabeprazole 29% 19% Saquinavir 27% 49% Spironolactone 25% NA Telmisartan 20 to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude is Unclear Alprazolam,… (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Drug Interactions Some studies have shown that simultaneous sucralfate administration in healthy volunteers reduced the extent of absorption (bioavailability) of single doses of the following: cimetidine, digoxin, fluoroquinolone antibiotics, ketoconazole, l-thyroxine, phenytoin, quinidine, ranitidine, tetracycline, and theophylline. (Fachinformation zu Sucralfat, Arzneimittelwechselwirkungen)

…15% Nifedipine 45% NA Propantheline 24% 24% Quinine NA 33% Rabeprazole 29% 19% Saquinavir 27% 49% Spironolactone 25% NA Telmisartan 20 to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude is Unclear Alprazolam, Azithromycin, Cyclosporine, Diclofenac, Diphenoxylate, Epoprostenol, Esomeprazole, Ibuprofen,… (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Drug Interactions: Reduced absorption of folic acid and digoxin have been reported when those agents were administered concomitantly with sulfasalazine. (Fachinformation zu Sulfasalazin, Arzneimittelwechselwirkungen)

Digoxin: Concomitant use with sumatriptan and naproxen sodium tablets can increase serum concentration and prolong half-life of digoxin. (Fachinformation zu Sumatriptan und Naproxen, Arzneimittelwechselwirkungen)

Monitor patients who are at higher risk of developing QT interval prolongation, including patients with a history of QT interval prolongation, patients who are taking antiarrhythmics, or patients with relevant pre-existing cardiac disease, bradycardia, or electrolyte disturbances. (Fachinformation zu Sunitinib, Warnhinweise und Vorsichtsmaßnahmen)

Digoxin: Monitor digoxin concentrations ( 7.3 ). (Fachinformation zu Suvorexant, Arzneimittelwechselwirkungen)

Hyperkalemia QUELICIN may induce serious cardiac arrhythmias or cardiac arrest due to hyperkalemia in patients with electrolyte abnormalities and those who may have digitalis toxicity. (Fachinformation zu Suxamethonium, Warnhinweise und Vorsichtsmaßnahmen)

…electrocardiograms and monitoring electrolytes (magnesium, potassium, calcium) periodically during treatment in patients with congestive heart failure, bradyarrhythmias, those taking certain antiarrhythmic medications or other products that lead to QT prolongation, and those with electrolyte disturbances (e.g., hypokalemia, hypocalcemia, or hypomagnesemia). (Fachinformation zu Tacrolimus, Warnhinweise und Vorsichtsmaßnahmen)

Digoxin and Theophylline Dosage adjustments are not necessary when a tamsulosin hydrochloride capsule is administered concomitantly with digoxin or theophylline [see Clinical Pharmacology ( 12.3 )] . (Fachinformation zu Tamsulosin, Arzneimittelwechselwirkungen)

…20% NA Indomethacin 40% NA Mirabegron 29% 27% Nefazodone 27% 15% Nifedipine 45% NA Propantheline 24% 24% Quinine NA 33% Rabeprazole 29% 19% Saquinavir 27% 49% Spironolactone 25% NA Telmisartan 20 to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude is Unclear Alprazolam, Azithromycin, Cyclosporine,… (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

…20% NA Indomethacin 40% NA Mirabegron 29% 27% Nefazodone 27% 15% Nifedipine 45% NA Propantheline 24% 24% Quinine NA 33% Rabeprazole 29% 19% Saquinavir 27% 49% Spironolactone 25% NA Telmisartan 20 to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude is Unclear Alprazolam, Azithromycin, Cyclosporine,… (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

…20% NA Indomethacin 40% NA Mirabegron 29% 27% Nefazodone 27% 15% Nifedipine 45% NA Propantheline 24% 24% Quinine NA 33% Rabeprazole 29% 19% Saquinavir 27% 49% Spironolactone 25% NA Telmisartan 20 to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude is Unclear Alprazolam, Azithromycin, Cyclosporine,… (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Parathyroid Hormone Analog Teriparatide Sporadic case reports have suggested that hypercalcemia may predispose patients to digitalis toxicity. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

…are known to prolong QTc, including antipsychotic medications (e.g., chlorpromazine, haloperidol, thioridazine, ziprasidone), antibiotics (e.g., moxifloxacin), Class 1A (e.g., quinidine, procainamide) and Class III (e.g., amiodarone, sotalol) antiarrhythmic medications or any other medications known to prolong the QTc interval [see Drug Interactions ( 7.5 )]. (Fachinformation zu Tetrabenazin, Warnhinweise und Vorsichtsmaßnahmen)

Use in Thyroid Disorders and Hypermetabolic States Hypothyroidism may reduce the requirements for digoxin. (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

…Mirabegron 29% 27% Nefazodone 27% 15% Nifedipine 45% NA Propantheline 24% 24% Quinine NA 33% Rabeprazole 29% 19% Saquinavir 27% 49% Spironolactone 25% NA Telmisartan 20 to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude is Unclear Alprazolam, Azithromycin, Cyclosporine, Diclofenac, Diphenoxylate,… (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Beta-adrenergic Blockers and Calcium Channel Blockers Additive effects on AV node conduction can result in complete heart block. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

…Nefazodone 27% 15% Nifedipine 45% NA Propantheline 24% 24% Quinine NA 33% Rabeprazole 29% 19% Saquinavir 27% 49% Spironolactone 25% NA Telmisartan 20 to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude is Unclear Alprazolam, Azithromycin, Cyclosporine, Diclofenac, Diphenoxylate, Epoprostenol,… (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Agents generally accepted to prolong QT interval include Class 1A (e.g., quinidine, procainamide, disopyramide) and Class III (e.g., amiodarone, sotalol, ibutilide, dofetilide) antiarrhythmics; certain antipsychotics (e.g., thioridazine, haloperidol); certain antidepressants (e.g., venlafaxine, amitriptyline); certain antibiotics (e.g., erythromycin, clarithromycin,… (Fachinformation zu Toremifen, Arzneimittelwechselwirkungen)

Digoxin Clinical Impact: Post-marketing surveillance of tramadol has revealed rare reports of digoxin toxicity. (Fachinformation zu Tramadol, Arzneimittelwechselwirkungen)

Digoxin Clinical Impact: Post-marketing surveillance of tramadol has revealed rare reports of digoxin toxicity. (Fachinformation zu Tramadol und Paracetamol, Arzneimittelwechselwirkungen)

Digoxin or Phenytoin: Monitor for increased digoxin or phenytoin serum levels ( 7 ). (Fachinformation zu Trazodon, Arzneimittelwechselwirkungen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

…15% Nifedipine 45% NA Propantheline 24% 24% Quinine NA 33% Rabeprazole 29% 19% Saquinavir 27% 49% Spironolactone 25% NA Telmisartan 20 to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude is Unclear Alprazolam, Azithromycin, Cyclosporine, Diclofenac, Diphenoxylate, Epoprostenol, Esomeprazole, Ibuprofen,… (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Digoxin Clinical Implication: Concomitant use of INGREZZA or INGREZZA SPRINKLE with digoxin increased digoxin levels because of inhibition of intestinal P-glycoprotein (P-gp) [see Clinical Pharmacology ( 12.3 )] . (Fachinformation zu Valbenazin, Arzneimittelwechselwirkungen)

Serum potassium levels should be carefully monitored when digoxin is given to patients at high risk of hypokalemia ( e.g. , those receiving diuretics, corticosteroids, or other drugs that commonly lead to potassium loss; those with gastrointestinal losses through diarrhea, vomiting, or nasogastric suction; or those with potassium-losing endocrinopathies or nephropathies). (Fachinformation zu Digoxin, Warnhinweise und Vorsichtsmaßnahmen)

Beta-adrenergic Blockers and Calcium Channel Blockers Additive effects on AV node conduction can result in complete heart block. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Concomitant use of VIIBRYD increased digoxin concentrations [see Clinical Pharmacology ( 12.3 )] . (Fachinformation zu Vilazodon, Arzneimittelwechselwirkungen)

In patients with renal impairment, the exposure to concomitant medications that are primarily renally excreted (e.g., digoxin) may increase. (Fachinformation zu Zoledronsäure, Arzneimittelwechselwirkungen)

Other: There appears to be no pharmacokinetic interaction between acitretin and cimetidine, digoxin, or glyburide. (Fachinformation zu Acitretin, Arzneimittelwechselwirkungen)

Effects of Adenosine on Other Drugs Adenosine injection has been given with other cardioactive drugs (such as beta adrenergic blocking agents, cardiac glycosides, and calcium channel blockers) without apparent adverse interactions, but its effectiveness with these agents has not been systematically evaluated. (Fachinformation zu Adenosin, Arzneimittelwechselwirkungen)

The drugs that inhibit cytochrome P450 2D6 include some that are not metabolized by the enzyme (quinidine; cimetidine) and many that are substrates for P450 2D6 (many other antidepressants, phenothiazines, and the Type 1C antiarrhythmics propafenone and flecainide). (Fachinformation zu Amitriptylin, Arzneimittelwechselwirkungen)

The drugs that inhibit cytochrome P450 2D6 include some that are not metabolized by the enzyme (quinidine, cimetidine) and many that are substrates for P450 2D6 (many other antidepressants, phenothiazines, and the Type 1C antiarrhythmics propafenone and flecainide). (Fachinformation zu Amoxapin, Arzneimittelwechselwirkungen)

Norepinephrine Dopamine Neuromuscular Blocking Agents Succinylcholine May cause sudden extrusion of potassium from muscle cells causing arrhythmias in patients taking digoxin. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Norepinephrine Dopamine Neuromuscular Blocking Agents Succinylcholine May cause sudden extrusion of potassium from muscle cells causing arrhythmias in patients taking digoxin. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

The patient was also chronically receiving phenytoin, phenobarbital, digoxin, and Synthroid®. (Fachinformation zu Buspiron, Arzneimittelwechselwirkungen)

Cardiac Glycosides In a study of young healthy male subjects no evidence of a direct pharmacokinetic captopril-digoxin interaction could be found. (Fachinformation zu Captopril, Arzneimittelwechselwirkungen)

Norepinephrine Dopamine Neuromuscular Blocking Agents Succinylcholine May cause sudden extrusion of potassium from muscle cells causing arrhythmias in patients taking digoxin. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

The drugs that inhibit cytochrome P450 2D6 include some that are not metabolized by the enzyme (quinidine; cimetidine) and many that are substrates for P450 2D6 (many other antidepressants, phenothiazines, and the Type IC antiarrhythmics propafenone and flecainide). (Fachinformation zu Desipramin, Arzneimittelwechselwirkungen)

Other Cardiovascular Agents Enalaprilat injection, USP has been used concomitantly with digitalis, beta adrenergic-blocking agents, methyldopa, nitrates, calcium-blocking agents, hydralazine and prazosin without evidence of clinically significant adverse interactions. (Fachinformation zu Enalaprilat, Arzneimittelwechselwirkungen)

Drugs That Slow Heart Rate or Atrioventricular Conduction (e.g., beta blockers or diltiazem) Experience with GILENYA in patients receiving concurrent therapy with drugs that slow the heart rate or AV conduction (e.g., beta blockers, digoxin, or heart rate-slowing calcium channel blockers, such as diltiazem or verapamil) is limited. (Fachinformation zu Fingolimod, Arzneimittelwechselwirkungen)

In addition, fondaparinux sodium neither influenced the pharmacodynamics of warfarin sodium, acetylsalicylic acid, piroxicam, and digoxin, nor the pharmacokinetics of digoxin at steady state. (Fachinformation zu Fondaparinux, Arzneimittelwechselwirkungen)

Some traditional Chinese and Ayurvedic medicine substances like Chan Su, Siberian Ginseng, Asian Ginseng, Ashwagandha or Dashen, can cause similar interference. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Examples include (but are not limited to): Class 1A antiarrhythmics (e.g., procainamide, quinidine, disopyramide); Class 3 antiarrhythmics (e.g., amiodarone, sotalol); and other drugs such as citalopram, erythromycin, levofloxacin, methadone, and ziprasidone. (Fachinformation zu Haloperidol, Arzneimittelwechselwirkungen)

Other Interactions Digitalis, tetracyclines, nicotine, or antihistamines, or intravenous nitroglycerin may partially counteract the anticoagulant action of heparin sodium. (Fachinformation zu Heparin, Arzneimittelwechselwirkungen)

These include Class 1A (e.g., quinidine, procainamide) or Class III (e.g., amiodarone, sotalol) antiarrhythmics, certain antipsychotics (e.g., ziprasidone, iloperidone, clozapine, quetiapine, chlorpromazine), certain antidepressants (e.g., citalopram, fluoxetine), certain antibiotics (e.g., azithromycin, erythromycin, clarithromycin, gatifloxacin, moxifloxacin);… (Fachinformation zu Hydroxyzin, Vorsichtsmaßnahmen)

The drugs that inhibit cytochrome P450 2D6 include some that are not metabolized by the enzyme (quinidine; cimetidine) and many that are substrates for P450 2D6 (many other antidepressants, phenothiazines, and the Type 1C antiarrhythmics propafenone and flecainide). (Fachinformation zu Imipramin, Arzneimittelwechselwirkungen)

Norepinephrine Dopamine Neuromuscular Blocking Agents Succinylcholine May cause sudden extrusion of potassium from muscle cells causing arrhythmias in patients taking digoxin. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Cardiac Rhythm and Conduction Abnormalities In vitro testing showed that lamotrigine exhibits Class IB antiarrhythmic activity at therapeutically relevant concentrations [see Clinical Pharmacology ( 12.2 )] . (Fachinformation zu Lamotrigin, Warnhinweise und Vorsichtsmaßnahmen)

• PGP Inducers/Inhibitors: Drugs that induce or inhibit PGP have the potential to alter digoxin pharmacokinetics. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Drug Interactions No untoward clinical manifestations have been observed in limited experience with patients in whom milrinone was used concurrently with the following drugs: digitalis glycosides; lidocaine, quinidine; hydralazine, prazosin; isosorbide dinitrate, nitroglycerin; chlorthalidone, furosemide, hydrochlorothiazide, spironolactone; captopril; heparin,… (Fachinformation zu Milrinon, Arzneimittelwechselwirkungen)

Moexipril hydrochloride has been used in clinical trials concomitantly with calcium-channel-blocking agents, diuretics, H 2 blockers, digoxin, oral hypoglycemic agents, and cholesterol-lowering agents. (Fachinformation zu Moexipril, Arzneimittelwechselwirkungen)

Sixteen (16) drugs tested did not show an in vitro interaction with LOKELMA (allopurinol, apixaban, aspirin, captopril, cyclosporine, digoxin, ethinyl estradiol, lisinopril, magnesium, metformin, phenytoin, prednisone, propranolol, quinapril, spironolactone and ticagrelor). (Fachinformation zu Natrium-Zirconium-Cyclosilicat, Arzneimittelwechselwirkungen)

The drugs that inhibit cytochrome P450 2D6 include some that are not metabolized by the enzyme (quinidine; cimetidine) and many that are substrates for P450 2D6 (many other antidepressants, phenothiazines, and the Type 1C antiarrhythmics propafenone and flecainide). (Fachinformation zu Nortriptylin, Arzneimittelwechselwirkungen)

Norepinephrine Dopamine Neuromuscular Blocking Agents Succinylcholine May cause sudden extrusion of potassium from muscle cells causing arrhythmias in patients taking digoxin. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Pentoxifylline extended-release tablets have been used concurrently with antihypertensive drugs, beta blockers, digitalis, diuretics, and antiarrhythmics, without observed problems. (Fachinformation zu Pentoxifyllin, Arzneimittelwechselwirkungen)

Drug Interactions Metabolism of a number of medications, including antipsychotics, antidepressants, β-blockers, and antiarrhythmics, occurs through the cytochrome P450 2D6 isoenzyme (debrisoquine hydroxylase). (Fachinformation zu Perphenazin, Arzneimittelwechselwirkungen)

Effient can be administered with aspirin (75 mg to 325 mg per day), heparin, GPIIb/IIIa inhibitors, statins, digoxin, and drugs that elevate gastric pH, including proton pump inhibitors and H 2 blockers [see Clinical Pharmacology (12.3) ] . (Fachinformation zu Prasugrel, Arzneimittelwechselwirkungen)

Drug Interactions Prazosin hydrochloride capsules have been administered without any adverse drug interaction in limited clinical experience to date with the following: (1) cardiac glycosides– digitalis and digoxin; (2) hypoglycemics–insulin, chlorpropamide, phenformin, tolazamide, and tolbutamide; (3) tranquilizers and sedatives–chlordiazepoxide, diazepam, and… (Fachinformation zu Prazosin, Arzneimittelwechselwirkungen)

The drugs that inhibit cytochrome P450 2D6 include some that are not metabolized by the enzyme (quinidine; cimetidine) and many that are substrates for P450 2D6 (many other antidepressants, phenothiazines, and the Type 1C antiarrhythmics, propafenone and flecainide). (Fachinformation zu Protriptylin, Vorsichtsmaßnahmen)

Aminoglycoside antibiotics, local and some general anesthetics, antiarrhythmic agents, and other drugs that interfere with neuromuscular transmission should be used cautiously, if at all. (Fachinformation zu Pyridostigmin, Arzneimittelwechselwirkungen)

Other Concomitant Medications EVISTA can be concomitantly administered with ampicillin, amoxicillin, antacids, corticosteroids, and digoxin [see Clinical Pharmacology ( 12.3 )] . (Fachinformation zu Raloxifen, Arzneimittelwechselwirkungen)

Drug Interactions Clinical studies of interactions of Ribavirin for Inhalation Solution, USP with other drugs commonly used to treat infants with RSV infections, such as digoxin, bronchodilators, other antiviral agents, antibiotics or anti-metabolites, have not been conducted. (Fachinformation zu Ribavirin, Arzneimittelwechselwirkungen)

Digoxin Oral RISPERDAL (0.25 mg twice daily) did not show a clinically relevant effect on the pharmacokinetics of digoxin. (Fachinformation zu Risperidon, Arzneimittelwechselwirkungen)

Norepinephrine Dopamine Neuromuscular Blocking Agents Succinylcholine May cause sudden extrusion of potassium from muscle cells causing arrhythmias in patients taking digoxin. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Digoxin The effect of co‑administration of silodosin capsules and digoxin 0.25 mg/day for 7 days was evaluated in a clinical trial in 16 healthy males, aged 18 to 45 years. (Fachinformation zu Silodosin, Arzneimittelwechselwirkungen)

Drugs predominantly metabolized by the CYP450 2D6 isozyme include the following drug classes: tricyclic antidepressants, selective serotonin reuptake inhibitors, beta-blockers, antiarrhythmics class 1C (e.g., flecainide and propafenone) and monoamine oxidase inhibitors Type B. (Fachinformation zu Terbinafin, Arzneimittelwechselwirkungen)

Moderate or Weak CYP1A2 Inhibitors Concomitant use of Zanaflex with moderate or weak CYP1A2 inhibitors (e.g., zileuton, antiarrhythmics [amiodarone, mexiletine, propafenone, and verapamil], cimetidine, famotidine, oral contraceptives, acyclovir, and ticlopidine) should be avoided. (Fachinformation zu Tizanidin, Arzneimittelwechselwirkungen)

The drugs that inhibit cytochrome P450 2D6 include some that are not metabolized by the enzyme (quinidine; cimetidine) and many that are substrates for P450 2D6 (many other antidepressants, phenothiazines, and the Type 1C antiarrhythmics propafenone and flecainide). (Fachinformation zu Trimipramin, Arzneimittelwechselwirkungen)

Norepinephrine Dopamine Neuromuscular Blocking Agents Succinylcholine May cause sudden extrusion of potassium from muscle cells causing arrhythmias in patients taking digoxin. (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Drug-drug interaction studies in healthy subjects have been conducted with zileuton immediate-release tablets and digoxin, phenytoin, sulfasalazine, and naproxen. (Fachinformation zu Zileuton, Arzneimittelwechselwirkungen)

In vitro data in human plasma indicate that Doxazosin has no effect on protein binding of digoxin, warfarin, phenytoin, or indomethacin. (Fachinformation zu Doxazosin, Arzneimittelwechselwirkungen)

RPV did not have a clinically significant effect on the pharmacokinetics of digoxin or metformin. (Fachinformation zu Emtricitabin, Rilpivirin und Tenofovir, Arzneimittelwechselwirkungen)

Compounds that have been tested in man have included antipyrine, digoxin, propranolol, theophylline, and warfarin and no clinically meaningful interactions were found. (Fachinformation zu Finasterid, Arzneimittelwechselwirkungen)

Digoxin: Administration of fluvoxamine maleate 100 mg daily for 18 days (N=8) did not significantly affect the pharmacokinetics of a 1.25 mg single intravenous dose of digoxin. (Fachinformation zu Fluvoxamin, Arzneimittelwechselwirkungen)

Digoxin In a study in 12 patients with congestive heart failure where ketoprofen and digoxin were concomitantly administered, ketoprofen did not alter the serum levels of digoxin. (Fachinformation zu Ketoprofen, Warnhinweise und Vorsichtsmaßnahmen)

Drug Interactions No clinically significant drug interactions have been found in studies of losartan potassium with hydrochlorothiazide, digoxin, warfarin, cimetidine and phenobarbital. (Fachinformation zu Losartan, Arzneimittelwechselwirkungen)

Digoxin In patients with hypercholesterolemia, concomitant administration of lovastatin and digoxin resulted in no effect on digoxin plasma concentrations. (Fachinformation zu Lovastatin, Arzneimittelwechselwirkungen)

No dose adjustment is needed when SINGULAIR is co-administered with theophylline, prednisone, prednisolone, oral contraceptives, fexofenadine, digoxin, warfarin, gemfibrozil, itraconazole, thyroid hormones, sedative hypnotics, non-steroidal anti-inflammatory agents, benzodiazepines, decongestants, and Cytochrome P450 (CYP) enzyme inducers [see Clinical Pharmacology… (Fachinformation zu Montelukast, Arzneimittelwechselwirkungen)

Digoxin A controlled pharmacokinetic study has shown no effect on plasma digoxin concentrations when coadministered with perindopril erbumine, but an effect of digoxin on the plasma concentration of perindopril/perindoprilat has not been excluded. (Fachinformation zu Perindopril, Arzneimittelwechselwirkungen)

Quinapril hydrochloride treatment did not affect the pharmacokinetics of digoxin. (Fachinformation zu Quinapril, Arzneimittelwechselwirkungen)

Rilpivirine did not have a clinically significant effect on the pharmacokinetics of digoxin or metformin. (Fachinformation zu Rilpivirin, Arzneimittelwechselwirkungen)

Drug Interaction Studies Digoxin: Coadministration of ropinirole (2 mg 3 times daily) with digoxin (0.125 to 0.25 mg once daily) did not alter the steady-state pharmacokinetics of digoxin in 10 patients. (Fachinformation zu Ropinirol, Arzneimittelwechselwirkungen)

Additionally, no dosage adjustment is required for diazepam, lithium, atenolol, tolbutamide, digoxin, and drugs metabolized by CYP3A4, when sertraline hydrochloride capsules is administered concomitantly [see Clinical Pharmacology ( 12.3 )] . (Fachinformation zu Sertralin, Arzneimittelwechselwirkungen)

Table 5: Sevelamer Drug Interactions Oral drugs for which sevelamer did not alter the pharmacokinetics when administered concomitantly Digoxin Enalapril Iron Metoprolol Warfarin Oral drugs that have demonstrated interaction with sevelamer and are to be dosed separately from sevelamer carbonate Dosing Recommendations Ciprofloxacin Take at least 2 hours before… (Fachinformation zu Sevelamer, Arzneimittelwechselwirkungen)

P-glycoprotein (e.g. Digoxin) — Coadministration of tadalafil (40 mg once per day) for 10 days did not have a significant effect on the steady-state pharmacokinetics of digoxin (0.25 mg/day) in healthy subjects. (Fachinformation zu Tadalafil, Arzneimittelwechselwirkungen)

Digoxin : Concomitant administration of tiagabine did not affect the steady-state pharmacokinetics of digoxin or the mean daily trough serum level of digoxin. (Fachinformation zu Tiagabin, Arzneimittelwechselwirkungen)

Other No clinically significant pharmacokinetic interaction has been found between trandolaprilat and food, cimetidine, digoxin, or furosemide. (Fachinformation zu Trandolapril, Arzneimittelwechselwirkungen)

Concomitant use with digoxin did not affect the pharmacokinetics of either drug. (Fachinformation zu Trospiumchlorid, Arzneimittelwechselwirkungen)

Drugs with a Narrow Therapeutic Index Digoxin: Zaleplon (10 mg) did not affect the pharmacokinetic or pharmacodynamic profile of digoxin (0.375 mg q24h for 8 days). (Fachinformation zu Zaleplon, Arzneimittelwechselwirkungen)