DIGOXIN AND PROTEASE INHIBITORS
A woman had elevated serum digoxin levels and signs of toxicity after she was given ritonavir. Pharmacokinetic studies have shown that ritonavir and saquinavir with
ritonavir cause modest to marked increases in single-dose digoxin levels.
It would seem prudent to closely monitor patients taking digoxin when ritonavir is started or stopped. Note that there appears to be a greater effect with intravenous digoxin than with oral digoxin. There do not appear to be any reports or studies of the interaction of digoxin with other protease inhibitors; however, most protease inhibitors are inhibitors and/or substrates for P-glycoprotein, so it would seem likely that they may all interact to a greater or lesser degree.
ritonavir cause modest to marked increases in single-dose digoxin levels.
It would seem prudent to closely monitor patients taking digoxin when ritonavir is started or stopped. Note that there appears to be a greater effect with intravenous digoxin than with oral digoxin. There do not appear to be any reports or studies of the interaction of digoxin with other protease inhibitors; however, most protease inhibitors are inhibitors and/or substrates for P-glycoprotein, so it would seem likely that they may all interact to a greater or lesser degree.