Digoxin and Telmisartan: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Telmisartan
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
An increased digoxin exposure
Interaction Deep Dive
Coadministration of digoxin and telmisartan (P-gp inhibitor) may increase digoxin exposure. Drugs that affect renal function, like telmisartan (angiotensin receptor blocker) may impair the excretion of digoxin. Reduce digoxin concentrations by decreasing the dose by approximately 15-30% or by modifying the dosing frequency and continue monitoring. Also, monitor potential signs and symptoms of clinical toxicity is necessary when initiating, adjusting, or discontinuing telmisartan12.
Why it happens (mechanism)
Inhibition of P-gp mediated efflux transport of digoxin; reduced GFR or tubular secretion; impaired secretion of digoxin
Literature reports
2 reports — tap to read
a) During pharmacokinetic studies, coadministration of telmisartan and oral digoxin resulted in a 20% to 49% increase in digoxin exposure 12.
b) A multiple-dose, open label, two-period crossover randomized study in 12 healthy volunteers demonstrated that coadministration of telmisartan and digoxin resulted in higher serum digoxin concentrations than when digoxin is administered alone. Digoxin AUC was increased by 22%, Cmax by 50%, and Cmin by 13% with telmisartan plus digoxin compared with digoxin alone. The clinical significance of these findings in a small group of healthy male volunteers has not been determined 3.
Common questions
Can I take Digoxin and Telmisartan together?
An increased digoxin exposure Always confirm with your pharmacist or prescriber before making any change.
How serious is the Digoxin and Telmisartan 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.
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 Telmisartan 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)
- 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
- Stangier J, Su C, Hendriks M, et al: The effect of telmisartan on the steady-state pharmacokinetics of digoxin in healthy male volunteers. J Clin Pharmacol 2000; 40:1373-1379. DOI
Keep reading about Telmisartan
Keep reading about Digoxin
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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