Drug Interaction Report

Nitrendipine and Digoxin: Interaction Details

A pharmacist-reviewed analysis of the Nitrendipine 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®
+

Nitrendipine

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
LinkedIn
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 8 documented Nitrendipine interactions, 7 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
established
Severity
Major

What happens

An increased risk of bradycardia and an increased risk of complete heart block

Interaction Deep Dive

Coadministration of digoxin and a calcium channel blocker may have additive effects on AV node conduction and increase the risk of bradycardia and advanced or complete heart block1243.

Why it happens (mechanism)

Additive effects on AV node conduction

Literature reports

7 reports — tap to read

a) In a double blind, placebo controlled study of 48 healthy subjects, the concurrent use of bepridil 100 mg three times daily with digoxin 0.125 mg three times daily increased digoxin concentration by a mean of 34% over a 1 week period. It was not known if the serum digoxin concentrations at that time had reached final steady-state levels. Coadministration of both drugs resulted in additive chronotropic effects and the increased digoxin effects diminished the negative ionotropic effect of bepridil. Administration of bepridil with digoxin resulted in minimal change of digoxin's positive ionotropic activity. Patients receiving digoxin and bepridil should be monitored carefully, however, reduction in digoxin dosages may not be necessary 9.

b) The in vitro addition of digoxin and bepridil to human serum did not result in altered bepridil protein binding 10.

c) Concomitant administration of calcium channel blockers (NIFEdipine, dilTIAZem, niCARdipine, verapamil) and digitalis glycosides (digoxin) occasionally results in up to 50% increases in serum digoxin concentrations 11. The magnitude of increase appears to be dependent on the dose of calcium channel blocker being used 1257.

d) The magnitude of increase in digoxin concentration is generally of minimal clinical significance 68, patients with higher pre-existing serum digoxin concentrations are at greater risk for digoxin toxicity 57.

e) Concomitant administration of digoxin 0.25 mg twice daily and nisoldipine 10 mg twice daily has been reported to result in significant increases in plasma concentrations of digoxin in patients with heart failure 1314. The mechanism of this interaction is unclear. It does not appear to involve an effect of nisoldipine on digoxin renal clearance 14.

f) The results of a double-blind, placebo-controlled study of concurrent treatment with nisoldipine and digoxin were reported. Nine patients with heart failure were treated for at least two weeks with digoxin 0.25 mg twice daily, followed by one week of either digoxin plus placebo (D+P) or digoxin plus nisoldipine 10 mg twice daily (D+N). An increase in digoxin trough levels was seen on day 7 in D+N (0.98 +/- 0.15 nanogram/mL (ng/mL) or 1.255 +/- 0.192 nanomol/L vs 1.3 +/- 0.21 ng/mL or 1.66 +/- 0.269 nanomol/L; P less than 0.05) compared with D+P. Mean digoxin plasma levels for days 5, 6, and 7 were higher with D+N (1.16 +/- 1.4 mg/mL or 1.485 +/- 1.79 mmol/L vs 1.35 +/- 0.14 mg/mL or 1.729 +/- 0.179 mmol/L; P less than 0.02) compared with D+P. Eight hours after coadministration of D+N, the pre-ejection period was shortened from 139 +/- 11 with D+P to 129 +/- 11 milliseconds (P less than 0.05), but this may have been due to the action of nisoldipine alone. No adverse effects from the increased digoxin levels were seen in the patients in this study, but some patients may experience clinical effects from this interaction 15.

g) Concomitant nitrendipine 20 mg once daily and digoxin 0.5 mg twice daily given for three days, followed by digoxin 0.25 mg twice daily given an additional four days to six healthy volunteers, reportedly resulted in no significant changes in the pharmacokinetic parameters of nitrendipine. However, coadministration did result in significant increases in the digoxin plasma concentrations, from 0.96 mcg/L to 1.98 mcg/L. Two patients experienced toxic concentrations (greater than 2 mcg/L) and adverse effects, which were described as impaired sense of smell, flickering before the eyes, and inability to concentrate 16. Concomitant administration of nitrendipine 20 mg daily and digoxin 0.25 mg twice daily was reported to result in significant increases in digoxin plasma levels and AUC in healthy volunteers. Combined therapy with nitrendipine 10 mg once daily did not produce significant increases in AUC or plasma levels of digoxin. These data suggest that monitoring of digoxin serum levels may be prudent in patients receiving nitrendipine, especially in higher doses 17. In another study, nitrendipine did not significantly affect digoxin pharmacokinetics. When oral nitrendipine 20 mg twice daily was administered to ten healthy volunteers given oral beta-acetyldigoxin 0.3 mg once daily (following a 0.6 mg loading dose), digoxin serum concentrations decreased only slightly and urinary digoxin excretion was not altered 18.

Common questions

Can I take Nitrendipine and Digoxin together?

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

How serious is the Nitrendipine 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 "established". Well documented — supported by controlled studies or strong clinical data.

Questions for your pharmacist

  • Does my dose of Nitrendipine 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 (18)

  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. Product Information: DIGOXIN intravenous injection, digoxin intravenous injection. Hikma Pharmaceuticals USA Inc. (per Dailymed), Berkeley Heights, NJ, 2023. DailyMed
  4. Product Information: LANOXIN® intravenous, intramuscular injection, digoxin intravenous, intramuscular injection. Covis Pharma (per FDA), King of Prussia, PA, 2025. DailyMed
  5. 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. DOI
  6. Schwartz JB & Migliore PJ: Effect of nifedipine on serum digoxin concentration and renal digoxin clearance. Clin Pharmacol Ther 1984; 36:19. PubMed
  7. 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
  8. Garty M, Shamir E, Ilfeld D, et al: Noninteraction of digoxin and nifedipine in cardiac patients. J Clin Pharmacol 1986; 26:304-305. PubMed
  9. Belz GG, Wistuba S, & Matthews JH: Digoxin and bepridil: pharmacokinetic and pharmacodynamic interactions. Clin Pharmacol Ther 1986; 39:65-71. PubMed
  10. Pritchard JF, McKown LA, Dvorchik BH, et al: Plasma protein binding of bepridil. J Clin Pharmacol 1985; 25:347-353. DOI
  11. Friedel HA & Sorkin EM: Nisoldipine: a preliminary review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in the treatment of angina pectoris, hypertension, and related cardiovascular disorders. Drugs 1988; 36:682-731.
  12. Clarke WR, Horn JR, Kawabori I, et al: Potentially serious drug interactions secondary to high-dose diltiazem used in the treatment of pulmonary hypertension. Pharmacotherapy 1993; 13:402-405. DOI
  13. Kirch W, Stenzel J, Santos SR, et al: Nisoldipine, a new calcium antagonist, elevates plasma levels of digoxin. Arch Toxicol Suppl 1987; 11:310-312. PubMed
  14. Friedel HA & Sorkin EM: Nisoldipine: a preliminary review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in the treatment of angina pectoris, hypertension and related cardiovascular disorders. Drugs 1988; 36:682-731.
  15. Kirch W, Stenzel J, Dylewicz P, et al: Influence of nisoldipine on haemodynamic effects and plasma levels of digoxin. Br J Clin Pharmacol 1986; 22:155-159. PubMed
  16. Kirch W, Hutt HJ, Heidemann H, et al: Drug interactions with nitrendipine. J Cardiovasc Pharmacol 1984; 6:S982-S985. DOI
  17. Kirch W, Logemann C, Heidemann H, et al: Nitrendipine/digoxin interaction. J Cardiovasc Pharmacol 1987; 10(suppl 10):S74-S75. DOI
  18. Ziegler R, Wingender W, Boehme K, et al: Study of pharmacokinetic and pharmacodynamic interaction between nitrendipine and digoxin. J Cardiovasc Pharmacol 1987; 9:S101-S106. DOI
Was this write-up helpful?
Digoxin

Keep reading about Digoxin

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

Keep reading about Nitrendipine

All Nitrendipine interactions (8)
Also serious with: Clonidine Transdermal Patch Epirubicin Ketoconazole Topical Lacosamide 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
Nitrendipine + Activated Charcoal Coleus Grapefruit St. John's Wort Acacia Rigidula Adrafinil African Wild Potato American Elder + 135 more

major · moderate · minor — check everything you take with our drug–supplement interaction checker.

Check another combination

Our instant two-drug interaction checker is almost here.

Coming soon

The instant two-drug checker is on its way.

In the meantime, browse the directory below to look up any drug and see its documented interactions.

Still have questions about this combination?

Every question gets a real answer from a licensed pharmacist — free, and usually within a day.

Ask the pharmacist
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.