Acarbose and Digoxin: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Digoxin
Acarbose
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Reduced digoxin exposure
Interaction Deep Dive
Coadministration of digoxin and acarbose may reduce digoxin exposure12. AUC and Cmax of digoxin were significantly decreased in the presence of acarbose in 1 study 4 and case reports have described subtherapeutic levels of digoxin after acarbose was added to a regimen 53. Measure digoxin concentrations prior to initiation of concurrent use. Increase the digoxin dose by approximately 20% to 40%, if necessary, and continue monitoring digoxin exposure 12.
Why it happens (mechanism)
Reduced digoxin absorption
Literature reports
3 reports — tap to read
a) A 69 year old woman with hypertension, unstable angina, congestive heart failure, and insulin-dependent diabetes was treated with several drugs including digoxin. The patient received digoxin 0.25 mg daily in addition to commonly recommended dosages of several other drugs. After the addition of acarbose to the patient's regimen, digoxin levels were measured to be subtherapeutic, at 0.48 ng/mL. After noncompliance was investigated and then ruled out as the causative factor, the digoxin dose was increased by 0.125 mg two times a week in addition to the daily dose of 0.25 mg. The next measured digoxin level was again subtherapeutic at 0.64 ng/mL. After discontinuation of acarbose for ten days, and resumption of digoxin therapy at 0.25 mg daily, measured levels of digoxin were 1.90 ng/mL (normal range: 0.8 to 2.1 ng/mL). After ruling out interactions with the patient's other medications, the authors speculated that the subtherapeutic levels of digoxin could be due to an interaction with acarbose through an unknown mechanism 3.
b) Seven healthy male volunteers participated in a randomized, crossover study to determine the effect of acarbose on the pharmacokinetic parameters of digoxin. In phase 1, participants received a single oral dose of digoxin 0.5 mg. Phase 2 consisted of administering a 0.5 mg dose of digoxin 30 minutes after acarbose 200 mg. During phase 3, subjects were given acarbose 100 mg three times daily for three days, and on the fourth day they received a digoxin 0.5 mg dose after the acarbose dose. During phase 2, the maximum concentration (Cmax) of digoxin decreased approximately 30% (1.99 ng/mL vs. 1.43 ng/mL) while the bioavailability was reduced by 40%. Even though the dose of acarbose in phase 3 was half of the dose in phase 2, the Cmax of digoxin was less (1.22 ng/mL) than in phase 2. The area under the concentration-time curve (AUC) from 0 to 48 hours was also reduced in phases 2 and 3 from 22.3 ng/hr/mL to 13.6 ng/hr/mL and 12.8 ng/hr/mL, respectively. These findings suggest that acarbose inhibits the absorption of digoxin from the gastrointestinal tract 4.
c) Two patients experienced subtherapeutic digoxin levels when acarbose was added to their drug regimen. Patient 1, a 50 year-old male, was stabilized on digoxin when acarbose 50 mg three times daily was initiated. Three months later, he presented to the emergency room with rapid atrial fibrillation. His digoxin level at that time was 0.23 ng/mL. Acarbose was discontinued for seven days, and his digoxin dose remained at 0.25 mg daily. The digoxin level increased back to a therapeutic level (1.6 ng/mL). To test the hypothesis that acarbose was the offending agent, acarbose was reinstated, and the patient's digoxin level decreased to 0.76 ng/mL. The second patient, a 72 year-old female, was started on acarbose 100 mg twice daily. Her digoxin plasma levels were subtherapeutic on two different occasions, ranging from 0.56 ng/mL to 0.72 ng/mL. Following the discontinuation of digoxin, her plasma level increased to 1.9 ng/mL 5.
Common questions
Can I take Acarbose and Digoxin together?
Reduced digoxin exposure Always confirm with your pharmacist or prescriber before making any change.
How serious is the Acarbose and Digoxin interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Acarbose or Digoxin need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (5)
- Product Information: LANOXIN(R) oral tablets, digoxin oral tablets. Concordia Pharmaceuticals Inc (per FDA), Kansas City, MO, 2019. DailyMed
- Product Information: DIGOXIN oral tablets, digoxin oral tablets. Aurobindo Pharma USA, Inc. (per Dailymed), East Windsor, NJ, May. DailyMed
- Serrano JS, Jimenez CM, Serrano MI, et al: A possible interaction of clinical interest between digoxin and acarbose. Clin Pharmacol Ther 1996; 60:589-592.
- Miura T, Ueno K, Tanaka K, et al: Impairment of absorption of digoxin by acarbose. J Clin Pharmacol 1998; 38:654-657. PubMed
- Ben-Ami H, Krivoy N, Nagachandran P, et al: An interaction between digoxin and acarbose. Diabetes Care 1999; 22:860-861. DOI
Keep reading about Digoxin
Keep reading about Acarbose
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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