Drug Interaction Report

Digoxin and Voclosporin: Interaction Details

A pharmacist-reviewed analysis of the Digoxin and Voclosporin 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

Digoxin

Cardoxin® Digitek Digitek® Digox Lanoxicaps® Lanoxin Lanoxin®
+

Voclosporin

Lupkynis Lupkynis®
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
unspecified
Evidence
probable
Severity
Major

What happens

Increased digoxin exposure

Interaction Deep Dive

Coadministration of voclosporin (P-gp inhibitor) increases exposure of P-gp substrates, which may increase the risk of adverse reactions. If using voclosporin concomitantly with digoxin, a P-gp substrate with a narrow therapeutic window, reduce the dosage of digoxin as needed. In a study, coadministration of voclosporin and digoxin increased the digoxin AUC by 25% and Cmax by 51%1. Additionally, increase monitoring of serum digoxin concentrations and for potential signs and symptoms of clinical toxicity when initiating, adjusting, or discontinuing drugs that may interact with digoxin 2.

Why it happens (mechanism)

Inhibition of P-gp-mediated efflux transport of digoxin

Literature reports

1 report — tap to read

a) Coadministration of voclosporin (P-gp inhibitor) 0.4 mg/kg twice daily and digoxin (P-gp substrate) increased the digoxin AUC by 25% and Cmax by 51% 1.

Common questions

Can I take Digoxin and Voclosporin together?

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

How serious is the Digoxin and Voclosporin 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 Voclosporin 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 (2)

  1. Product Information: LUPKYNIS(TM) oral capsules, voclosporin oral capsules. Aurinia Pharma US Inc (per FDA), Rockville, MD, 2024. DailyMed
  2. Product Information: LANOXIN(R) oral tablets, digoxin oral tablets. Concordia Pharmaceuticals Inc (per DailyMed), Kansas City, MO, 2020. DailyMed
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Digoxin

Keep reading about Digoxin

All Digoxin interactions (453) Digoxin drug information
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Voclosporin

Keep reading about Voclosporin

All Voclosporin interactions (92) Voclosporin drug information
Also serious with: Lefamulin Ketoconazole Topical Atogepant Ofloxacin Otic
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:

Digoxin + Activated Charcoal Aloe Blue Flag Danshen European Buckthorn Foxglove Indian Snakeroot Lily-of-the-valley + 105 more
Voclosporin + Activated Charcoal American Hellebore Arsenic Asarabacca Cesium Ephedra Grapefruit Siberian Cocklebur + 144 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.