Itraconazole; Ketoconazole/Digoxin Interactions

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.

Medical warning:

Serious. These medicines may interact and cause very harmful effects. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.

How the interaction occurs:

The cause of the interaction is not known.

What might happen:

Your blood levels of digoxin may increase and cause toxic effects.

What you should do about this interaction:

Make sure your healthcare professionals (e.g. doctor or pharmacist) know that you are taking these medicines together. If you experience changes in vision, loss of appetite, nausea, vomiting, diarrhea, dizziness, weakness, or irregular heartbeat, contact your doctor. It may be necessary to adjust your dose of digoxin.Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.

  • 1.Sporanox (itraconazole) US prescribing information. Janssen Pharmaceutica Products, L.P. May, 2018.
  • 2.Jalava KM, Partanen J, Neuvonen PJ. Itraconazole decreases renal clearance of digoxin. Ther Drug Monit 1997 Dec;19(6):609-13.
  • 3.Partanen J, Jalava KM, Neuvonen PJ. Itraconazole increases serum digoxin concentration. Pharmacol Toxicol 1996 Nov;79(5):274-6.
  • 4.Rex J. Itraconazole-digoxin interaction. Ann Intern Med 1992 Mar 15; 116(6):525.
  • 5.Kauffman CA, Bagnasco FA. Digoxin toxicity associated with itraconazole therapy. Clin Infect Dis 1992 Nov;15(5):886-7.
  • 6.Sachs MK, Blanchard LM, Green PJ. Interaction of itraconazole and digoxin. Clin Infect Dis 1993 Mar;16(3):400-3.
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  • 8.McClean KL, Sheehan GJ. Interaction between itraconazole and digoxin. Clin Infect Dis 1994 Feb;18(2):259-60.
  • 9.Mathis AS, Friedman GS. Coadministration of digoxin with itraconazole in renal transplant recipients. Am J Kidney Dis 2001 Feb;37(2):E18.
  • 10.Wakasugi H, Ishizuka R, Koreeda N, Yano I, Futami T, Nohara R, Sasayama S, Inui K. Effect of itraconazole on digoxin clearance in patients with congestive heart failure. Yakugaku Zasshi 2000 Sep;120(9):807-11.
  • 11.Alderman CP, Allcroft PD. Digoxin-itraconazole interaction: possible mechanisms. Ann Pharmacother 1997 Apr;31(4):438-40.
  • 12.Cone LA, Himelman RB, Hirschberg JN, Hutcheson JW. Itraconazole-related amaurosis and vomiting due to digoxin toxicity. West J Med 1996 Nov; 165(5):322.
  • 13.Meyboom RH, de Jonge K, Veentjer H, Dekens-Konter JA, de Koning GH. Potentiation of digoxin by itraconazole. Ned Tijdschr Geneeskd 1994 Nov 19;138(47):2353-6.
  • 14.Mochizuki M, Murase S, Takahashi K, Shimada S, Kume H, Iizuka T, Fukuda M. Serum itraconazole and hydroxyitraconazole concentrations and interaction with digoxin in a case of chronic hypertrophic pachymenigitis caused by Aspergillus flavus. Nippon Ishinkin Gakkai Zasshi 2000; 41(1):33-9.
  • 15.Purkins L, Wood N, Kleinermans D, Nichols D. Voriconazole does not affect the steady-state pharmacokinetics of digoxin. Br J Clin Pharmacol 2003 Dec;56 Suppl 1:45-50.
  • 16.Lanoxin (digoxin) Tablets US prescribing information. Covis Pharmaceuticals, Inc. August, 2018.
  • 17.Nizoral (ketoconazole oral) US prescribing information. Janssen Pharmaceuticals February, 2014.

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CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.