digoxin and ibuprofen

Ibuprofen inhibits renal prostaglandin synthesis, reducing renal blood flow and glomerular filtration. This decreases renal clearance of digoxin, leading to elevated serum digoxin concentrations. Additionally, NSAID-induced sodium and water retention may oppose the effects of diuretics, potentially worsening heart failure.

Elevated digoxin levels increase the risk of digoxin toxicity, manifested by nausea, vomiting, anorexia, visual disturbances, bradycardia, and serious cardiac arrhythmias (e.g., heart block, ventricular ectopy). The risk is higher in patients with renal impairment, pre-existing heart failure, or concurrent potassium-lowering agents.

Avoid co-prescribing digoxin and ibuprofen when possible, especially in patients with renal impairment or heart failure. If the combination is necessary, monitor serum digoxin concentrations, renal function (e.g., creatinine, eGFR), serum potassium, and signs of digoxin toxicity. Consider alternative analgesics such as paracetamol or tramadol. Adjust the digoxin dose based on monitoring.

Established interaction; supported by clinical studies and case reports. Widely documented in drug interaction reference sources and consistent with the pharmacological properties of both drugs.