Digoxin — interactions

Not a CYP drug at all — a P-glycoprotein substrate, and exquisitely sensitive to potassium. Two different mechanisms on this page reach it.

Also known as: Lanoxin, digitalis. Category: medication. Narrow therapeutic index.

What it does, mechanism by mechanism

P-glycoprotein inhibition — substrate, strong

Blocks the efflux pump that ejects drugs back into the gut lumen and out of the brain. Raises absorption of P-gp substrates like digoxin, and can raise brain exposure independently of blood level.

Sources: U.S. Food and Drug Administration 2023 · more on P-glycoprotein inhibition

P-glycoprotein induction — substrate, strong

Increases the efflux pump, lowering absorption. St John's wort does this and CYP3A4 induction at the same time — two mechanisms pointing the same way.

Sources: Johne A 1999 · more on P-glycoprotein induction

11β-HSD2 inhibition (pseudohyperaldosteronism) — substrate, strong

Blocks the enzyme that inactivates cortisol in the kidney, so cortisol acts on the mineralocorticoid receptor. Produces the picture of excess aldosterone with low aldosterone: sodium retention, potassium loss, hypertension.

Digoxin binds the same site on the sodium-potassium ATPase that potassium does, so when serum potassium falls, digoxin binding rises and the drug becomes more toxic at an unchanged blood level. Digoxin toxicity is potentiated by hypokalaemia — so anything that lowers potassium (licorice, thiazide and loop diuretics) raises digoxin risk without changing the digoxin level at all.

Sources: Omar HR 2012 · more on 11β-HSD2 inhibition (pseudohyperaldosteronism)

Specific combinations

What a clean result means here

A clean result means NO DOCUMENTED INTERACTION IN THIS DATASET. It does not mean safe, and it is not a clearance. Most substances are not in this dataset at all, and for many pairs that are, nobody has ever studied the combination.

In this dataset

  • Monoamine oxidase inhibition (prescription MAOIs, RIMAs, linezolid, methylene blue, harmala alkaloids)
  • Serotonergic drugs and the serotonin-toxicity mechanism
  • Dietary tyramine and L-dopa loads
  • The major cytochrome P450 pathways: CYP3A4, CYP2D6, CYP1A2, CYP2C9, CYP2C19 — inhibition and induction
  • P-glycoprotein inhibition and induction
  • 11β-HSD2 inhibition (the licorice mechanism) and the potassium consequences that follow it
  • QT prolongation as an additive pharmacodynamic axis
  • Culinary seasonings and common foods with documented pharmacological activity
  • A selected set of narrow-therapeutic-index drugs where those shifts matter most

Not in this dataset

  • Any substance not named in this dataset — which is most substances. There are tens of thousands of marketed drugs and this table holds fewer than a hundred entries.
  • Phase-2 conjugation (UGT, SULT, NAT2, COMT) except where a specific entry names it. The oilahuasca corpus turns heavily on phase 2 and this engine models it only in passing.
  • Pharmacogenomics. CYP2D6 and CYP2C19 are strongly polymorphic; a poor metaboliser and an ultra-rapid metaboliser can have opposite outcomes from the same pair, and this engine does not know your genotype.
  • Dose, timing, duration, formulation and route — all of which change whether a documented interaction is clinically real for you.
  • Renal and hepatic impairment, age, pregnancy, and body composition.
  • Additive sedation, respiratory depression, bleeding risk, hypoglycaemia and most other pharmacodynamic axes beyond the ones listed above.
  • Herb–herb interactions outside the named entries, and essentially the whole botanical world: most plants have no interaction literature at all.
  • Allergy, intolerance, and contamination or adulteration of unregulated products.
  • Anything published after the last-reviewed date below.

72 substances, 20 mechanisms, 64 citations. Last reviewed . Primary literature (every DOI resolved against the Crossref API) and FDA drug labelling. There is no free, openly-licensed, comprehensive drug-interaction dataset to draw on; NLM retired its Drug Interaction API on 2024-01-02 and DrugBank's interaction set is a commercial licence.

References

  1. U.S. Food and Drug Administration (2023). Drug Development and Drug Interactions: Table of Substrates, Inhibitors and Inducers. FDA. https://www.fda.gov/drugs/drug-interactions-labeling/drug-development-and-drug-interactions-table-substrates-inhibitors-and-inducers
  2. Johne A, Brockmöller J, Bauer S, Maurer A, Langheinrich M, Roots I (1999). Pharmacokinetic interaction of digoxin with an herbal extract from St John's wort (Hypericum perforatum). Clinical Pharmacology & Therapeutics. doi:10.1053/cp.1999.v66.a101944
  3. Omar HR, Komarova I, El-Ghonemi M, et al. (2012). Licorice abuse: time to send a warning message. Therapeutic Advances in Endocrinology and Metabolism. doi:10.1177/2042018812454322

Every DOI above was resolved against the Crossref API on 2026-09-09 and the returned title checked against the one printed here. Three DOIs in the first draft resolved to real but different papers and were corrected before publication.

Last reviewed . All interaction pages.