MajorHMG-CoA reductase inhibitors (statins)×Cardiac glycosides (digitalis)
Updated · Methodology
Mechanism
Atorvastatin slightly raises digoxin levels: by about 22%, with a 15% rise in AUC, according to the FDA digoxin label. Digoxin has a narrow therapeutic range, so even this increase can lead to toxicity.
Symptoms
Nausea, anorexia, visual disturbances (yellow-green halos around lights), arrhythmias. Older patients: confusion.
Management
Before starting atorvastatin, measure the serum digoxin concentration, then reduce the digoxin dose by about 15–30% or give it less often and keep monitoring the concentration (FDA digoxin label). Draw the sample just before the next digoxin dose or at least 6 hours after the last one (FDA digoxin label). The atorvastatin labels ask for appropriate monitoring of patients taking digoxin (atorvastatin labels).
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- AEMPS: Ficha técnica: Atorvastatina (nº registro 69536), sección 4.5 (2024)– AEMPS, CIMA, nº registro 69536, sección 4.5
- FDA: Lanoxin (digoxin) prescribing information (2024)– FDA label, DailyMed setid d91e3646-4c63-4512-ab22-db39c085c4dc, revised 12/2024, sections 2.5, 5.3, 7.1, 7.2, 12.3 and 17
- FDA: Lipitor (atorvastatin) prescribing information (2024)– DailyMed setid a60cc18b-0631-4cf0-b021-9f52224ece65, revisión 04/2024, secciones 2.5, 4, 5.1 y 7.1