Digoxin and Colestipol: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Colestipol
Digoxin
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
Colestipol may decrease digitalis glycoside absorption and increase clearance by interrupting the enterohepatic cycle35. Coadministration of digoxin and colestipol may reduce digoxin exposure. Measure digoxin exposure 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
2 reports — tap to read
a) There is conflicting information concerning the effect of concomitant digoxin and colestipol therapy. Colestipol may bind digitalis glycosides in the gastrointestinal tract, thereby impairing their initial absorption and enterohepatic circulation. The half-life of elimination of digoxin was 55 hours versus the predicted half-life of 85 hours when colestipol was administered to a patient with digoxin intoxication 3. A reduction in plasma digitoxin levels was seen when colestipol was administered to four patients with digitoxin intoxication 4.
b) Colestipol may decrease digitalis glycoside absorption and increase clearance by interrupting the enterohepatic cycle 35. Decreased plasma levels of digitoxin were not seen in 11 patients administered colestipol 6. Colestipol 10 g did not reduce the absorption of digoxin 0.25 mg in six healthy volunteers 7.
Common questions
Can I take Digoxin and Colestipol together?
Reduced digoxin exposure Always confirm with your pharmacist or prescriber before making any change.
How serious is the Digoxin and Colestipol interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "rapid". Effects can appear quickly, often within about 24 hours of combining the drugs.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Digoxin or Colestipol 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 (7)
- 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
- Payne VW, Secter RA, & Noback RK: Use of colestipol in a patient with digoxin intoxication. Drug Intell Clin Pharm 1981; 15:902-903. PubMed
- Bazzano G & Bazzano GS: Digitalis intoxication. Treatment with a new steroid-binding resin. JAMA 1972a; 220:828-830. DOI
- Kilgore TL & Lehmann CR: Treatment of digoxin intoxication with colestipol. South Med J 1982; 75:1259-1260. PubMed
- van Bever RJ, Duchateau AM, Pluym BF, et al: The effect of colestipol on digitoxin plasma levels. Arzneimittelforschung 1976; 26:1891-1893.
- Neuvonen PJ, Kivisto K, & Hirvisalo EL: Effects of resins and activated charcoal on the absorption of digoxin, carbamazepine and frusemide. Br J Clin Pharmacol 1988; 25:229-233. DOI
Keep reading about Colestipol
Keep reading about Digoxin
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