Sucralfate and Digoxin: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Sucralfate
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
Reduced digoxin exposure
Interaction Deep Dive
Coadministration of digoxin and sucralfate 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. Concomitant single doses of oral sucralfate and digoxin caused a 19% decrease in digoxin bioavailability. When digoxin was given two hours before sucralfate, no interaction occurred. The mechanism is not established; presumably, there was a reduction in the gastrointestinal absorption of digoxin 4.
Why it happens (mechanism)
Reduced digoxin absorption
Literature reports
2 reports — tap to read
a) Subtherapeutic levels of digoxin, quiNIDine, and warfarin occurred in a 71 year-old patient, even though the administration of sucralfate was separated by two hours from the other agents. Following hospitalization, sucralfate was administered four hours apart from the remainder of the therapeutic regimen and was subsequently discontinued; digoxin and quiNIDine levels returned to therapeutic levels and the prothrombin time improved. Clinicians should be aware that sucralfate may reduce the bioavailability of other drugs, even if the administration times are staggered 3.
b) Concomitant single doses of oral sucralfate and digoxin caused a 19% decrease in digoxin bioavailability. When digoxin was given two hours before sucralfate, no interaction occurred. The mechanism is not established; presumably, there was a reduction in the gastrointestinal absorption of digoxin 4.
Common questions
Can I take Sucralfate and Digoxin together?
Reduced digoxin exposure Always confirm with your pharmacist or prescriber before making any change.
How serious is the Sucralfate 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.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Sucralfate 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 (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
- Rey AM & Gums JG: Altered absorption of digoxin, sustained-released quinidine, and warfarin with sucralfate administration. DICP 1991; 25:745-746.
- Giesing DH, Lanman RC, Dimmitt DC, et al: Lack of effect of sucralfate on digoxin pharmacokinetics (abstract). Gastroenterology 1983; 84:1165.
Keep reading about Sucralfate
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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