Digoxin and Ticagrelor: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Ticagrelor
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
Increased digoxin exposure
Interaction Deep Dive
Concomitant use of digoxin and ticagrelor (P-gp inhibitor) may increase the digoxin exposure. Monitor digoxin levels with initiation of or any change in ticagrelor therapy3. 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 ticagrelor 12.
Why it happens (mechanism)
Inhibition of P-gp-mediated efflux transport of digoxin
Literature reports
2 reports — tap to read
a) During pharmacokinetic studies, coadministration of ticagrelor and oral digoxin resulted in a 31% increase in digoxin serum concentrations and a 28% increase in digoxin AUC 12.
b) In a randomized crossover study among healthy volunteers (N=20), coadministration of digoxin and ticagrelor significantly increased systemic exposure to digoxin. All subjects received digoxin 0.25 mg twice a day on day 6 then 0.25 mg once daily on days 7 to 14, and were randomized to ticagrelor 400 mg once daily or placebo for days 1 to 16; following a 2-week washout period, the sequence was repeated with opposite intervention treatment. Concurrent use of digoxin and ticagrelor increased the digoxin Cmax by 75%, the minimum digoxin plasma concentration by 31%, and the mean digoxin AUC by 28% compared with administration of digoxin and placebo 4.
Common questions
Can I take Digoxin and Ticagrelor together?
Increased digoxin exposure Always confirm with your pharmacist or prescriber before making any change.
How serious is the Digoxin and Ticagrelor 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.
Questions for your pharmacist
- Does my dose of Digoxin or Ticagrelor 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
- Product Information: BRILINTA(R) oral tablets, ticagrelor oral tablets. AstraZeneca Pharmaceuticals LP (per FDA), Wilmington, DE, 2024. DailyMed
- Teng R & Butler K: A pharmacokinetic interaction study of ticagrelor and digoxin in healthy volunteers. Eur J Clin Pharmacol 2013; 69(10):1801-1808. PubMed
Keep reading about Ticagrelor
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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