Drug Interaction Report

Neomycin and Digoxin: Interaction Details

A pharmacist-reviewed analysis of the Neomycin and Digoxin 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®
+

Neomycin

No brand names on record
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 19 documented Neomycin interactions, 11 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

Reduced digoxin exposure

Interaction Deep Dive

Coadministration of digoxin and neomycin may reduce digoxin exposure. Measure digoxin exposure prior to initiation of concurrent use. Increase the digoxin dose by approximately 20% to 40%, if necessary, and continue monitoring digoxin exposure12. Oral neomycin has been shown to reduce the rate and extent of oral digoxin absorption by interfering with intestinal absorption of digoxin 3.

Why it happens (mechanism)

Reduced digoxin absorption

Literature reports

1 report — tap to read

a) In a cross-over study using healthy volunteers it was noted that concurrent digoxin and neomycin decreased serum digoxin levels, area under the concentration time curve for digoxin, and cumulative urinary digoxin excretion; the time to peak digoxin concentration was increased. Even a single dose of neomycin (1 gram) inhibited digoxin absorption. The effect occurred when solutions were substituted for tablets, tablets with varying dissolution rates were used, and dosing times for the 2 drugs were separated. The mechanism of decreased absorption is not understood 3.

Common questions

Can I take Neomycin and Digoxin together?

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

How serious is the Neomycin and Digoxin 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 Neomycin or Digoxin 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: 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. Lindenbaum J, Maulitz RM, & Butler VP Jr: Inhibition of digoxin absorption by neomycin. Gastroenterology 1976; 71:399-404. DOI
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Digoxin

Keep reading about Digoxin

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

Keep reading about Neomycin

All Neomycin interactions (19)
Also serious with: Methotrexate Injection Aspirin Rectal Furosemide Injection Cidofovir 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:

Digoxin + Activated Charcoal Aloe Blue Flag Danshen European Buckthorn Foxglove Indian Snakeroot Lily-of-the-valley + 105 more
Neomycin + Activated Charcoal Asarabacca Siberian Cocklebur Aristolochia Bacillus Coagulans Bacillus Subtilis Bifidobacterium Animalis Subsp. Lactis Bifidobacterium Bifidum + 47 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.