MAJOR — Use With Caution
FDA-documented interaction. Monitor digoxin levels during and after clarithromycin treatment. Dose reduction may be needed.
Evidence level: STRONG
Clarithromycin (Biaxin) can significantly increase digoxin levels in your blood. Since digoxin has a very narrow safety margin, even small increases can cause toxic effects including dangerous heart rhythms.
Clarithromycin inhibits P-glycoprotein, reducing digoxin renal and biliary elimination. Also may reduce digoxin metabolism by gut flora (Eubacterium lentum). FDA labels document this.
If prescribed clarithromycin while on digoxin, ask about digoxin level monitoring. Report any nausea, vision changes, or irregular heartbeat immediately.
Follow each medication's specific timing instructions. Clarithromycin — check if it requires an empty stomach or should be taken with food. Digoxin follows its normal schedule. Complete the full antibiotic course as prescribed.
Renal impairment, elderly, pre-existing elevated digoxin levels
Nausea, vomiting, loss of appetite, visual changes (halos around lights), irregular or slow heartbeat, confusion
Request digoxin level check during clarithromycin course. Discuss alternative antibiotics like azithromycin. Know the signs of digoxin toxicity.
Antibiotic interactions are often temporary (duration of treatment). Space supplements and probiotics 2-3 hours away from antibiotic doses. Ask your pharmacist if timing adjustments can reduce the interaction risk.
Clarithromycin (Biaxin) can significantly increase digoxin levels in your blood. Since digoxin has a very narrow safety margin, even small increases can cause toxic effects including dangerous heart rhythms.
Follow each medication's specific timing instructions. Clarithromycin — check if it requires an empty stomach or should be taken with food. Digoxin follows its normal schedule. Complete the full antibiotic course as prescribed.
Nausea, vomiting, loss of appetite, visual changes (halos around lights), irregular or slow heartbeat, confusion
Antibiotic interactions are often temporary (duration of treatment). Space supplements and probiotics 2-3 hours away from antibiotic doses. Ask your pharmacist if timing adjustments can reduce the interaction risk.
Request digoxin level check during clarithromycin course. Discuss alternative antibiotics like azithromycin. Know the signs of digoxin toxicity.
Or browse the full interaction database (121,000+ pairs).