MajorCardiac glycosides (digitalis)×Reversible P2Y12 receptor inhibitor
Updated · Methodology
Mechanism
Ticagrelor inhibits P-glycoprotein, which clears digoxin. Digoxin peak concentration rises by 75%, AUC by 28% and trough levels by about 30%, doubling in some individuals.
Symptoms
Nausea, yellow vision, bradycardia.
Management
Measure serum digoxin before starting ticagrelor. Then reduce the digoxin dose by about 15–30% or give it less often, and keep monitoring levels (FDA digoxin label). Check digoxin levels when ticagrelor is started and after any change in its dose (FDA ticagrelor label). The EMA ticagrelor label also requires appropriate clinical and laboratory monitoring with this combination. Ticagrelor itself can cause ventricular pauses and bradycardia, so use it with caution with drugs that slow the heart rate (EMA ticagrelor label). Take blood for digoxin just before the next dose or at least 6 hours after the last one (FDA digoxin label).
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
- FDA: Brilinta (ticagrelor) prescribing information, Section 4.3 (2015)
- AEMPS: Ficha técnica: Ticagrelor (nº registro 89536), sección 4.5 (2026)– AEMPS, CIMA, nº registro 89536, sección 4.5
- FDA: Ticagrelor Tablets – Prescribing Information (2026)– FDA, DailyMed SPL, Teva Pharmaceuticals, раздел 7.5, пересмотр этикетки 08/2026
- 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
- EMA: Ficha técnica: Ticagrelor (EU/1/10/655), secciones 4.4 y 4.5 (2026)– EMA, ficha técnica de Brilique (EU/1/10/655) en CIMA, nº registro 10655004, texto vigente en CIMA a 03/10/2026, sin fecha de revisión, secciones 4.4 y 4.5