Digoxin and Omeprazole: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Digoxin
Omeprazole
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, an increased risk of digoxin toxicity (nausea, vomiting, arrhythmias) and an increased risk of hypomagnesemia
Interaction Deep Dive
Digoxin toxicity has been described in patients receiving omeprazole concurrently213. Proposed mechanisms of action include the phenotypic or age-related alterations in digoxin metabolism, or an increase in digoxin bioavailability caused by omeprazole's inhibition of gastric acid secretion 2. Monitor digoxin levels and for signs and symptoms of digoxin toxicity in patients requiring concomitant digoxin and omeprazole therapy. Digoxin dose adjustment may be needed to maintain therapeutic drug concentrations. Monitor magnesium levels prior to initiation of proton pump inhibitors treatment and periodically in patients on digoxin therapy. Supplement with magnesium as necessary 3.
Why it happens (mechanism)
Increased digoxin absorption; alterations in digoxin metabolism
Literature reports
3 reports — tap to read
a) Concomitant administration of omeprazole 20 mg once daily and digoxin in healthy subjects increased the bioavailability of digoxin by 10% (30% in two subjects) 3.
b) In a randomized, 2-way crossover study, 10 patients were given digoxin 1 mg alone. They were also given omeprazole 20 mg daily for 11 days; digoxin 1 mg was given on day 8. The AUC for digoxin increased about 10% with concomitant therapy. The net effect was minimal with respect to changes in digoxin levels and would not be clinically significant for most patients 1.
c) A 65-year-old Caucasian woman experienced signs of digoxin toxicity and an elevated serum digoxin level 3 months after starting omeprazole 20 mg concurrently for GERD. The patient had a history of hyperlipidemia, osteoarthritis, type 2 diabetes mellitus, recurrent nephrolithiasis, and paroxysmal atrial fibrillation, and had been stable on oral digoxin 0.625 mg daily for 6 years prior to the current presentation. Concomitant medications included meloxicam, lisinopril, raloxifene, atorvastatin, gemfibrozil, warfarin, oxybutynin, hydrochlorothiazide, and potassium citrate. Her serum digoxin level prior to starting the omeprazole was 1.1 nanogram/mL (ng/mL; 1.41 nanomol/L). She presented to the emergency department following an episode of emesis and had weakness, dysequilibrium, nausea, and altered vision. She reported experiencing yellow hazy vision 2 months prior, but denied any other neurologic symptoms and had no history of neurologic disease. Her ECG revealed bigeminy, a cardiac exam reported an irregular hear rate and a III/VI systolic ejection murmur, and her serum digoxin level was 3.9 ng/mL (4.99 nanomol/L). Her renal function was normal with serum creatinine 0.8 mg/dL (70.7 mcmol/L). She was administered digoxin antidote (digoxin immune fab) and was admitted to the ICU. Digoxin was stopped and her ECG returned to baseline within 2 days with no adverse effects. Proposed mechanisms of action include the phenotypic or age-related alterations in digoxin metabolism, or an increase in digoxin bioavailability caused by omeprazole's inhibition of gastric acid secretion 2.
Common questions
Can I take Digoxin and Omeprazole together?
Increased digoxin exposure, an increased risk of digoxin toxicity (nausea, vomiting, arrhythmias) and an increased risk of hypomagnesemia Always confirm with your pharmacist or prescriber before making any change.
How serious is the Digoxin and Omeprazole 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 Omeprazole 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 (3)
- Oosterhuis B, Jonkman JH, Andersson T, et al: Minor effect of multiple dose omeprazole on the pharmacokinetics of digoxin after a single oral dose. Br J Clin Pharmacol 1991; 32:569-572. PubMed
- Kiley CA, Cragin DJ, & Roth BJ: Omeprazole-associated digoxin toxicity. South Med J 2007; 100(4):400-402. DOI
- Product Information: KONVOMEP(TM) powder for oral suspension, omeprazole sodium bicarbonate powder for oral suspension. Azurity Pharmaceuticals Inc (per manufacturer), Woburn, MA, 2022. DailyMed
Keep reading about Digoxin
Keep reading about Omeprazole
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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