Digoxin and Rabeprazole: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Digoxin
Rabeprazole
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
An increased digoxin exposure
Interaction Deep Dive
Coadministration of digoxin and RABEprazole may increase digoxin exposure. Measure digoxin concentrations prior to initiation of concurrent use. Reduce the digoxin dose (by approximately 15% to 30% with oral preparations) or modify the dosing frequency. Continue monitoring digoxin exposure. Also, monitor potential signs and symptoms of clinical toxicity is necessary when initiating, adjusting, or discontinuing RABEprazole12. When oral digoxin 0.25 mg was given with RABEprazole 20 mg to 16 volunteers, a 22% increase in trough digoxin levels occurred. Digoxin AUC and Cmax also increased 19% and 29%, respectively 34.
Why it happens (mechanism)
Increased digoxin absorption
Literature reports
2 reports — tap to read
a) During pharmacokinetic studies, coadministration of RABEprazole and oral digoxin resulted in a 29% increase in digoxin serum concentrations and a 19% increase in digoxin AUC 12.
b) When oral digoxin 0.25 mg was given with RABEprazole 20 mg to 16 volunteers, a 22% increase in trough digoxin levels occurred. Digoxin AUC increased by 19% and Cmax increased by 29% 34.
Common questions
Can I take Digoxin and Rabeprazole together?
An increased digoxin exposure Always confirm with your pharmacist or prescriber before making any change.
How serious is the Digoxin and Rabeprazole 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 Rabeprazole 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 (4)
- 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
- Humphries TJHumphries TJ: A review of the drug-drug interaction potential of rabeprazole sodium based on CYP-450 interference or absorption effects, World Congress, Vienna, Austria, 1999.
- Product Information: Aciphex(R), rabeprazole sodium. Eisai Co. Ltd. Tokyo, Japan, 2002. DailyMed
Keep reading about Digoxin
Keep reading about Rabeprazole
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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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