Digoxin and Cyclosporine: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Cyclosporine
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
Increased digoxin exposure and an increased risk of digoxin toxicity
Interaction Deep Dive
Coadministration of digoxin and cycloSPORINE (P-gp inhibitor) increased digoxin exposure. Measure digoxin exposure prior to initiation of concurrent use. Continue monitoring digoxin exposure and reduce digoxin dose as necessary. Also, monitor potential signs and symptoms of clinical toxicity is necessary when initiating, adjusting, or discontinuing cycloSPORINE12. Severe digitalis toxicity has been seen within days of starting cycloSPORINE in several patients taking digoxin 45.
Why it happens (mechanism)
Inhibition of P-gp-mediated efflux transport of digoxin
Literature reports
2 reports — tap to read
a) Combined therapy with digoxin and cycloSPORINE reportedly resulted in digoxin toxicity in 2 patients with severe heart disease. Both patients were receiving digoxin 0.375 mg daily, and developed gastrointestinal symptoms and arrhythmias following initiation of cycloSPORINE therapy. Significant increases in digoxin serum levels were observed in both patients. A subsequent study involving 2 other patients demonstrated significant decreases in the volume of distribution, as well as decreases in plasma clearance, of digoxin following cycloSPORINE administration; the digoxin half-life increased significantly 3.
b) Severe digitalis toxicity has been seen within days of starting cycloSPORINE in several patients taking digoxin 45.
Common questions
Can I take Digoxin and Cyclosporine together?
Increased digoxin exposure and an increased risk of digoxin toxicity Always confirm with your pharmacist or prescriber before making any change.
How serious is the Digoxin and Cyclosporine interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "delayed". Effects tend to build up gradually over days to weeks.
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 Digoxin or Cyclosporine 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
- Dorian P, Strauss M, Cardella C, et al: Digoxin-cyclosporine interaction: severe digitalis toxicity after cyclosporine treatment. Clin Invest Med 1988; 11:108-112.
- Product Information: NEORAL(R) oral soft gelatin capsules oral solution, cyclosporine modified oral soft gelatin capsules oral solution. Novartis Pharmaceuticals Corporation (per FDA), East Hanover, NJ, 2023. DailyMed
- Product Information: SANDIMMUNE(R) oral capsules, oral solution, intravenous injection, cyclosporine oral capsules, oral solution, intravenous injection. Novartis Pharmaceuticals Corporation (per FDA), East Hanover, NJ, 2023. DailyMed
Keep reading about Cyclosporine
Keep reading about Digoxin
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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