Drug Interaction Report

Digoxin and Telithromycin: Interaction Details

A pharmacist-reviewed analysis of the Digoxin and Telithromycin 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

Telithromycin

No brand names on record
+

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
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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

Increased digoxin exposure

Interaction Deep Dive

Coadministration of digoxin and telithromycin (P-gp inhibitor) as it may increase digoxin exposure12. With coadministration of digoxin and telithromycin, monitor digoxin levels 3, and monitor for potential signs and symptoms of clinical toxicity when initiating, adjusting, or discontinuing telithromycin 12. The digoxin plasma peak level was increased by 73% and trough level by 21% in healthy volunteers when coadministered with telithromycin 3.

Why it happens (mechanism)

Inhibition of P-gp mediated efflux transport of digoxin

Literature reports

1 report — tap to read

a) The digoxin plasma peak level was increased by 73% and trough level by 21% in healthy volunteers when coadministered with telithromycin. Trough plasma concentrations of digoxin (when equilibrium between plasma and tissue concentrations had been achieved) ranged from 0.74 to 2.17 nanogram/mL (0.948 to 2.779 nanomol/L). There were no signs of digoxin toxicity and no significant changes in ECG parameters. Monitor digoxin serum levels and for digoxin side effects with concomitant administration 3.

Common questions

Can I take Digoxin and Telithromycin together?

Increased digoxin exposure Always confirm with your pharmacist or prescriber before making any change.

How serious is the Digoxin and Telithromycin 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 Telithromycin 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)

  1. Product Information: DIGOXIN oral tablets, digoxin oral tablets. Aurobindo Pharma USA, Inc. (per Dailymed), East Windsor, NJ, May. DailyMed
  2. Product Information: DIGOXIN intravenous injection, digoxin intravenous injection. Hikma Pharmaceuticals USA Inc. (per Dailymed), Berkeley Heights, NJ, 2023. DailyMed
  3. Product Information: KETEK(R) oral tablets, telithromycin oral tablets. Sanofi-Aventis U.S. LLC (per FDA), Bridgewater, NJ, 2015. DailyMed
Was this write-up helpful?
Telithromycin

Keep reading about Telithromycin

All Telithromycin interactions (146)
Also serious with: Lovastatin Simvastatin Alfuzosin Dihydroergotamine Injection
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:

Telithromycin + Activated Charcoal American Hellebore Arsenic Cesium Ephedra Grapefruit Sida Cordifolia St. John's Wort + 170 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.

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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.