Drug Interaction Report

Digoxin and Rifampin: Interaction Details

A pharmacist-reviewed analysis of the Digoxin and Rifampin interaction: the documented clinical effects, severity rating, onset, mechanism, and management considerations, with cited references throughout.

AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature

Rifampin

Rifadin
+

Digoxin

Cardoxin® Digitek Digitek® Digox Lanoxicaps® Lanoxin Lanoxin®
Dr. Brian Staiger, PharmD, BCPS
Medically reviewed by
Dr. Brian Staiger, PharmD, BCPS
Updated Aug 8, 2026
Editorial policy · Data sources
LinkedIn
Interaction severity
Major
Potentially serious — often needs a change or close monitoring.
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.

Of 453 documented Digoxin interactions, 359 are rated major — including this one.
Worried about symptoms right now? Contact your pharmacist or prescriber, or call Poison Control at 1-800-222-1222 (US). Call 911 for an emergency.
Onset
delayed
Evidence
probable
Severity
Major

What happens

Altered digoxin exposure and an increased risk of digoxin toxicity

Interaction Deep Dive

Concomitant use of digoxin and rifAMPin (P-gp inhibitor and P-gp inducer) may alter digoxin exposure143. Measure digoxin exposure prior to initiation of concurrent use. Increase the digoxin dose by approximately 20% to 40%, if necessary 567. Also, continue monitoring digoxin exposure and monitor potential signs and symptoms of clinical toxicity is necessary when initiating, adjusting, or discontinuing rifAMPin 12.

Why it happens (mechanism)

Induction of P-gp-mediated efflux transport of digoxin; inhibition of P-gp-mediated efflux transport of digoxin

Literature reports

1 report — tap to read

a) In a number of case reports the concomitant use of rifAMPin and digoxin has been shown to decrease digoxin concentrations to subtherapeutic levels 891011.

Common questions

Can I take Digoxin and Rifampin together?

Altered 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 Rifampin 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 Rifampin 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 (11)

  1. Product Information: LANOXIN(R) oral tablets, digoxin oral tablets. Concordia Pharmaceuticals Inc (per FDA), Kansas City, MO, 2019. DailyMed
  2. Product Information: DIGOXIN oral tablets, digoxin oral tablets. Aurobindo Pharma USA, Inc. (per Dailymed), East Windsor, NJ, May. DailyMed
  3. Product Information: DIGOXIN intravenous injection, digoxin intravenous injection. Hikma Pharmaceuticals USA Inc. (per Dailymed), Berkeley Heights, NJ, 2023. DailyMed
  4. Product Information: LANOXIN® intravenous, intramuscular injection, digoxin intravenous, intramuscular injection. Covis Pharma (per FDA), King of Prussia, PA, 2025. DailyMed
  5. Product Information: RIFADIN(R) IV intravenous injection, rifampin intravenous injection. sanofi-aventis US LLC (per FDA), Bridgewater, NJ, 2023. DailyMed
  6. Product Information: RIFADIN(R) oral capsules, rifampin oral capsules. sanofi-aventis US LLC (per FDA), Bridgewater, NJ, 2023. DailyMed
  7. Product Information: RIFATER(R) oral tablets, rifampin, isoniazid, pyrazinamide oral tablets. sanofi-aventis US LLC (per FDA), Bridgewater, NJ, 2023. DailyMed
  8. Boman G, Eliasson K, & Odar-Cederlof I: Acute cardiac failure during treatment with digitoxin - an interaction with rifampicin. Br J Clin Pharmacol 1980; 10:89-90. PubMed
  9. Poor DM, Self TH, & Davis HL: Interaction of rifampin and digitoxin. Arch Intern Med 1983; 143:599. DOI
  10. Novi C, Bissoli F, Simonati V, et al: Rifampin and digoxin: possible drug interaction in a dialysis patient (letter). JAMA 1980; 244:2521-2522. PubMed
  11. Gault H, Longerich L, Dawe M, et al: Digoxin-rifampin interaction. Clin Pharmacol Ther 1984; 35:750-754. DOI
Was this write-up helpful?
Rifampin

Keep reading about Rifampin

All Rifampin interactions (176)
Also serious with: Aficamten Fostemsavir Doravirine Nifedipine
Digoxin

Keep reading about Digoxin

All Digoxin interactions (453) Digoxin drug information
Also serious with: Levoketoconazole Meclofenamate Mavorixafor Parathyroid Hormone Injection
Beyond drug–drug

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:

Rifampin + Activated Charcoal Apple Asarabacca Beer Grapefruit Siberian Cocklebur St. John's Wort Sweet Orange + 214 more
Digoxin + Activated Charcoal Aloe Blue Flag Danshen European Buckthorn Foxglove Indian Snakeroot Lily-of-the-valley + 105 more

major · moderate · minor — check everything you take with our drug–supplement interaction checker.

Check another combination

Our instant two-drug interaction checker is almost here.

Coming soon

The instant two-drug checker is on its way.

In the meantime, browse the directory below to look up any drug and see its documented interactions.

Still have questions about this combination?

Every question gets a real answer from a licensed pharmacist — free, and usually within a day.

Ask the pharmacist
This information is for education, not a substitute for professional medical advice. Do not start, stop, or change any medication without talking to your pharmacist or prescriber.