Drug Interaction Report

Nifedipine and Digoxin: Interaction Details

A pharmacist-reviewed analysis of the Nifedipine 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®
+

Nifedipine

Adalat® Adalat® CC Afeditab CR Afeditab® CR Nifedical® XL Nifeditab® CR Procardia Procardia®
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 325 documented Nifedipine interactions, 266 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
rapid
Evidence
probable
Severity
Major

What happens

Increased digoxin exposure and an increased risk of bradycardia and advanced complete heart block

Interaction Deep Dive

Coadministration of digoxin and NIFEdipine (P-gp inhibitor and calcium channel blocker) may increase digoxin exposure, may also cause additive effects on AV node conduction which may result in bradycardia and advanced or complete heart block. Measure digoxin exposure before initiating concomitant drugs. 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 toxicity34, while initiating, adjusting, and discontinuing NIFEdipine to avoid possible over- or under-digitalization 21.

Why it happens (mechanism)

Inhibition of P-gp-mediated efflux transport of digoxin; additive effects on AV node conduction

Literature reports

5 reports — tap to read

a) During pharmacokinetic studies, coadministration of digoxin and NIFEdipine resulted in a 45% increase in digoxin serum concentrations 342. There have been isolated reports of patients with elevated digoxin levels 21.

b) The effect of NIFEdipine on digoxin pharmacokinetics is controversial. Some 56 have found steady-state digoxin concentrations to increase up to 50% following NIFEdipine, however, these results have not been confirmed by other studies 78910. Based upon a review of the literature, it is suggested that steady-state digoxin levels may increase from 24% to 45% when NIFEdipine is added to therapy, but that adverse effects have not been observed in patients studied. It is suggested that, with current available data, it is not possible to recommend routine alterations in digoxin dosage with NIFEdipine therapy. It is felt that the interaction is of minimal significance in most patients, but that digoxin serum level monitoring is warranted 11.

c) The effect of NIFEdipine 10 mg orally three times daily titrated to clinical response or tolerance on serum digoxin concentrations in 14 cardiac patients was evaluated. Patients had steady-state digoxin levels prior to entering the study and were allowed to continue concomitant medications which consisted primarily of long-acting nitrates, beta-blockers, and diuretics. The mean trough digoxin level was 0.78 nanogram/mL (ng/mL; 0.999 nanomol/L) before NIFEdipine and 0.8 ng/mL (1.02 nanomol/L) after 1 week of combined drug therapy and 0.84 ng/mL (1.076 nanomol/L) after 2 weeks of combined drug administration. These data suggest that cardiac patients stabilized on digoxin can receive combined digoxin and NIFEdipine without significantly altering the serum digoxin concentration 10.

d) NIFEdipine can delay gastric emptying and may potentially be of clinical concern in geriatric patients and in patients with diabetes or those who are taking digoxin, levodopa, or penicillin 12. Patients with higher pre-existing serum digoxin concentrations are at greater risk for digitalis toxicity 1314.

e) No interaction was reported between NIFEdipine and digoxin in patients with coronary artery disease. Digoxin 0.5 mg was administered IV on the fourth day of treatment with NIFEdipine 10 mg six times daily. NIFEdipine had no significant effect on the half-life, volume of distribution, clearance or percentage of digoxin recovered in the urine 15.

Common questions

Can I take Nifedipine and Digoxin together?

Increased digoxin exposure and an increased risk of bradycardia and advanced complete heart block Always confirm with your pharmacist or prescriber before making any change.

How serious is the Nifedipine 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 "rapid". Effects can appear quickly, often within about 24 hours of combining the drugs.

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 Nifedipine 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 (15)

  1. Product Information: NIFEDIPINE oral tablet, extended-release, nifedipine oral tablet, extended-release. Aurobindo Pharma Limited (per DailyMed), East Windsor, NJ, 2024. DailyMed
  2. Product Information: PROCARDIA XL(R) oral extended-release tablets, nifedipine oral extended-release tablets. Pfizer Labs (per Dailymed), New York, NY, 2023. DailyMed
  3. Product Information: LANOXIN(R) oral tablets, digoxin oral tablets. Concordia Pharmaceuticals Inc (per FDA), Kansas City, MO, 2019. DailyMed
  4. Product Information: DIGOXIN oral tablets, digoxin oral tablets. Aurobindo Pharma USA, Inc. (per Dailymed), East Windsor, NJ, May. DailyMed
  5. Belz GG, Doering W, Munkes R, et al: Interaction between digoxin and calcium antagonists and antiarrhythmic drugs. Clin Pharmacol Ther 1983; 33:410-417. PubMed
  6. Belz GG, Aust PE, & Munkes R: Digoxin plasma concentration and nifedipine. Lancet 1981; 1:844.
  7. Pedersen KE, Dorph-Pedersen A, Hvidt S, et al: Effect of nifedipine on digoxin kinetics in healthy subjects. Clin Pharmacol Ther 1982; 32:562-565. PubMed
  8. Koren G, Zylber-Katz E, Granit L, et al: Pharmacokinetic studies of nifedipine and digoxin co-administration. Int J Clin Pharmacol Ther Toxicol 1984; 24:39-42.
  9. Schwartz JB & Migliore PJ: Effect of nifedipine on serum digoxin concentration and renal digoxin clearance. Clin Pharmacol Ther 1984; 36:19. PubMed
  10. Schwartz JB, Raizner A, & Akers S: The effects of nifedipine on serum digoxin concentrations in patients. Am Heart J 1984; 107:669-673.
  11. Schwartz JB: Digoxin and nifedipine. Am J Cardiol 1985; 55:31E-34E. PubMed
  12. Goetsch RA, Fink S, & Chaudhuri TK: Effect of nifedipine on gastric emptying. Mil Med 1986; 151:438-439. DOI
  13. Andrejak M, Hary L, Andrejak MT, et al: Diltiazem increases steady state digoxin serum levels in patients with cardiac disease. J Clin Pharmacol 1987; 27:967-970. PubMed
  14. Yoshida A, Fujita M, Kurosawa N, et al: Effects of diltiazem on plasma level and urinary excretion of digoxin in healthy subjects. Clin Pharmacol Ther 1984; 35:681-685. PubMed
  15. Garty M, Shamir E, Ilfeld D, et al: Noninteraction of digoxin and nifedipine in cardiac patients. J Clin Pharmacol 1986; 26:304-305. PubMed
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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
Nifedipine + Activated Charcoal American Hellebore American Mistletoe Beer Coca Coleus Grapefruit Siberian Cocklebur + 265 more

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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.