Moderate
Acetylsalicylic acid × Digoxin
Antiplatelet agents (low dose) / NSAIDs (analgesic dose)×Cardiac glycosides (digitalis)
Mechanism
High aspirin doses can reduce renal digoxin clearance via prostaglandin-dependent renal blood flow suppression. The effect is clinically significant at analgesic aspirin doses (above 1 g/day), not cardioprotective ones.
Symptoms
Nausea, anorexia, visual disturbances (yellow-green halos around lights), arrhythmias at aspirin doses above 1 g/day.
Management
Cardioprotective aspirin doses are acceptable without adjustment. At high doses, check digoxin level at 1 week. For chronic analgesia on digoxin: paracetamol.
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.