Amiodarone increases digoxin blood levels by approximately 70 to 100 percent, which can cause digoxin toxicity. Symptoms of digoxin toxicity include nausea, vomiting, visual disturbances (yellow-green halos), confusion, and life-threatening cardiac arrhythmias.
How This Interaction Works (Mechanism)
Amiodarone inhibits P-glycoprotein (P-gp), the transporter responsible for digoxin excretion in the kidneys and GI tract. It also reduces renal clearance of digoxin through effects on renal tubular secretion. These combined effects can double digoxin plasma concentrations within one to two weeks of starting amiodarone. Since digoxin has a narrow therapeutic index (therapeutic range 0.5 to 2.0 ng/mL), even modest increases in blood levels can cause toxicity.
Source: Heart Rhythm Society Clinical Practice Guidelines, 2024
When amiodarone is added to digoxin therapy, the digoxin dose should be reduced by 50 percent immediately. Monitor digoxin levels closely (within one week of starting amiodarone and regularly thereafter). Watch for signs of toxicity: nausea, loss of appetite, visual changes, confusion, or new cardiac arrhythmias. Target digoxin levels of 0.5 to 0.9 ng/mL when used with amiodarone.
Check More Drug Interactions
Use our free interaction checker to search thousands of drug, supplement, and food combinations.
Open Interaction CheckerKeep a multi-drug routine straight
As an Amazon Associate I earn from qualifying purchases.
Sources and standards behind this page
What a drug interaction does, and how strongly it is supported, is documented in public labeling and federal safety references rather than in any one summary, and the sources below are the primary ones. They are linked so a reader can check a claim without taking this page's word for it.
- DailyMed carries the current FDA labeling for every marketed drug product, including the warnings and drug interaction sections.
- Drugs@FDA is the federal database of approved drug products and their approval documents.
- FDA: Drug interactions, what you should know explains how drug-drug, drug-food and drug-condition interactions are described on labels.
- FDA Drug Safety Communications publishes the agency's safety alerts and label changes as they are issued.
- FDA MedWatch is the program for reporting and reviewing adverse events, including suspected interactions.
- openFDA provides public access to FDA labeling and adverse event data.
- MedlinePlus drug information is the National Library of Medicine's consumer reference for what a medicine is and how it is taken.
- NIAAA: Harmful interactions documents which medicines interact with alcohol and how.
- NCCIH: Herb-drug interactions summarises the evidence on interactions between herbal products and medicines.
- National Library of Medicine maintains the drug and health databases the sources above draw on.
This page describes how this interaction works and where it is documented. It is not medical advice: a prescriber or pharmacist decides what applies to a particular patient and medication.
Frequently Asked Questions
Digoxin and Amiodarone have a severe interaction and should generally not be taken together without close medical supervision. The combination can cause serious, potentially life-threatening side effects. Contact your doctor immediately if you are currently taking both medications.
Amiodarone increases digoxin blood levels by approximately 70 to 100 percent, which can cause digoxin toxicity. Symptoms of digoxin toxicity include nausea, vomiting, visual disturbances (yellow-green halos), confusion, and life-threatening cardiac arrhythmias.
Yes. Anytime you are taking multiple medications, supplements, or substances, you should inform your doctor and pharmacist. They can evaluate your specific risk factors (age, kidney function, other medications, medical conditions) and determine whether the Digoxin and Amiodarone combination is safe for you, or whether adjustments are needed.
Related Resources
Get Drug Safety Alerts
Leave your email for updates on FDA warnings, new drug interactions, and patient safety information. We have not started sending yet, and we will only email when we do.