Digoxin and Metoclopramide Nasal Spray: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Metoclopramide Nasal Spray
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
Coadministration of digoxin and metoclopramide may reduce digoxin exposure due to increased gastrointestinal motility caused by metoclopramide resulting in reduced digoxin absorption. Monitor for reduced therapeutic effect of digoxin1. Significant reductions in the peak plasma concentration of digoxin (from 1.5 to 1.1 nanogram/mL or 1.92 to 1.41 nanomol/L) in healthy volunteers was reported following concomitant administration of metoclopramide 10 mg twice daily and digoxin 0.25 mg twice daily. Metoclopramide was also demonstrated to prolong the time to reach peak digoxin concentrations (from 2 to 2.7 hours), and reduced the digoxin area under the concentration-time curve (AUC) by 19% 5. Measure digoxin reduced prior to initiation of concurrent use. Increase the digoxin dose (by approximately 20% to 40% with oral preparations), if necessary, and continue monitoring digoxin exposure 23.
Why it happens (mechanism)
Reduced gastrointestinal absorption
Literature reports
2 reports — tap to read
a) Serum digoxin levels with or without metoclopramide were analyzed in 11 elderly women on maintenance digoxin therapy. Metoclopramide 10 mg three times daily was orally administered for 10 days resulting in a decrease in serum digoxin concentrations from initial levels of 0.72 nanogram/mL (ng/mL; 0.922 nanomol/L) to 0.46 ng/mL (0.589 nanomol/L). Withdrawal of metoclopramide resulted in a rise to normal levels over a period of 10 days. These changes are most likely a result of changes in gastrointestinal motility secondary to metoclopramide 4.
b) Significant reductions in the peak plasma concentration of digoxin (from 1.5 to 1.1 nanogram/mL or 1.92 to 1.41 nanomol/L) in healthy volunteers was reported following concomitant administration of metoclopramide 10 mg twice daily and digoxin 0.25 mg twice daily. Metoclopramide was also demonstrated to prolong the time to reach peak digoxin concentrations (from 2 to 2.7 hours), and reduced the digoxin area under the concentration-time curve (AUC) by 19% 5.
Common questions
Can I take Digoxin and Metoclopramide Nasal Spray together?
Reduced digoxin exposure Always confirm with your pharmacist or prescriber before making any change.
How serious is the Digoxin and Metoclopramide Nasal Spray 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 Digoxin or Metoclopramide Nasal Spray 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: REGLAN(R) oral tablets, metoclopramide oral tablets. ANI Pharmaceuticals, Inc. (per FDA), Baudette, MN, 2017. DailyMed
- 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
- Manninen V, Melin J, Apajalahti A, et al: Altered absorption of digoxin in patients given propantheline and metoclopramide. Lancet 1973; 1:398-400. PubMed
- Kirch W, Janisch HD, Santos SR, et al: Effect of cisapride and metoclopramide on digoxin bioavailability. Eur J Drug Metab Pharmacokinet 1986; 2:249-250. DOI
Keep reading about Metoclopramide Nasal Spray
Keep reading about Digoxin
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