Doses may be increased every 2 weeks according to clinical response. Use Caution/Monitor. Avoid or Use Alternate Drug. Measure serum digoxin concentrations before initiating concomitant drugs; continue monitoring and increase digoxin dose by approximately 20% to 40% as necessary. Either increases effects of the other by pharmacodynamic synergism. Applies only to oral form of both agents. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Use Caution/Monitor. Modify Therapy/Monitor Closely. sodium picosulfate/magnesium oxide/anhydrous citric acid decreases levels of digoxin by cation binding in GI tract. restrictions. Applies only to oral form of both agents. This dose should be divided into two or more doses starting with 50% then the remainder in 25% doses q6-8h. Comment: Prolonged use of PPIs may cause hypomagnesemia and increase risk for digoxin toxicity.Serious - Use Alternative (1)rabeprazole will increase the level or effect of digoxin by increasing gastric pH. perindopril increases levels of digoxin by unspecified interaction mechanism. Effect of interaction is not clear, use caution. Measure digoxin levels before initiating eliglustat and reduce digoxin dose by 30%; continue to monitor digoxin levels and adjust dose accordingly. Use Caution/Monitor. * All doses are based on ideal body weight for children with normal renal function. Comment: Vitamin D may cause hypercalcemia which may affect the actions of digoxin and/or lead to cardiac arrhythmias. Avoid or Use Alternate Drug. oxybutynin increases levels of digoxin by unspecified interaction mechanism. Monitor for decreased digoxin concentrations; bupropion may induce OATP4C1 transporter, which is involved in digoxin renal elimination. Coadministration of ferric maltol with certain oral medications may decrease the bioavailability of either ferric maltol and some oral drugs. Use Caution/Monitor. Applies only to oral form of both agents. Monitor Closely (1)celecoxib and digoxin both increase serum potassium. indinavir will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Maintenance dose1015 mcg/kg given daily in 2 divided doses. quercetin will decrease the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Can increase risk of bradycardia. Monitor Closely (1)calcium chloride increases effects of digoxin by pharmacodynamic synergism. Minor (1)digoxin decreases levels of magnesium citrate by increasing renal clearance. indomethacin and digoxin both increase serum potassium. lasmiditan increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Mechanism: unknown. Use Caution/Monitor. Minimum of a 4-fold dilution. Plasma concentrations and pharmacologic effects of digoxin may be increased by ritonavir. Monitor Closely (2)bisoprolol increases effects of digoxin by pharmacodynamic synergism. If possible, avoid coadministration or modify dose of OATP1B1/3 substrates coadministered with fostemsavir. . Minor (1)sitagliptin increases levels of digoxin by unspecified interaction mechanism. Dosage Adjustment When Changing Preparations The difference in bioavailability between injectable digoxin and oral digoxin must be considered when changing patients from one dosage form to another. Decrease digoxin dose by ~30-50% or by modifying dosing frequency and continue monitoring during coadministration. Information last revised July 2016. rabeprazole increases toxicity of digoxin by Other (see comment). Effect of interaction is not clear, use caution. celecoxib and digoxin both increase serum potassium. Immediate use of the diluted product is recommended. IVIM(Children 510 yr): Digitalizing dose1530 mcg/kg given as 50% of the dose initially and one quarter of the initial dose in each of 2 subsequent doses at 612 hr intervals. Use Caution/Monitor. tolfenamic acid and digoxin both increase serum potassium. . Avoid or Use Alternate Drug. Observe for signs and symptoms of toxicity. erythromycin stearate will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. View the formulary and any restrictions for each plan. An attempt has been made to determine a maximum safe digitalizing dose of digoxin for healthy premature infants. Use Caution/Monitor. Minor/Significance Unknown. Upon initiation or discontinuation of ustekinumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect. Monitor Closely (1)digoxin increases and albuterol decreases serum potassium. UR - https://www.drugguide.com/ddo/view/Davis-Drug-Guide/51218/all/digoxin Avoid or Use Alternate Drug. Use Caution/Monitor. Therefore, when initiating treatment, a special dosing regimen involving "loading doses" is used to rapidly increase digoxin plasma levels. Monitor Closely (1)saquinavir increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Monitor Closely (1)calcium acetate increases effects of digoxin by pharmacodynamic synergism. Comment: Prolonged use of PPIs may cause hypomagnesemia and increase risk for digoxin toxicity.Serious - Use Alternative (1)lansoprazole will increase the level or effect of digoxin by increasing gastric pH. sucralfate will decrease the level or effect of digoxin by inhibition of GI absorption. digoxin increases and chlorothiazide decreases serum potassium. Use Caution/Monitor. Effect of interaction is not clear, use caution. Comment: Prolonged use of PPIs may cause hypomagnesemia and increase risk for digoxin toxicity. Use Caution/Monitor. Contraindicated. digitalization: [ dij-tal--zashun ] the administration of digitalis in a dosage schedule designed to produce and then maintain optimal therapeutic concentrations of its cardiotonic glycosides. 2. Use Caution/Monitor. Monitor Closely (1)levothyroxine decreases effects of digoxin by unknown mechanism. Use Caution/Monitor. human parathyroid hormone, recombinant, digoxin. 10-15. Access up-to-date medical information for less than. Use Caution/Monitor. Monitor Closely (1)fostemsavir will increase the level or effect of digoxin by Other (see comment). lonafarnib will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Refer to digoxin prescribing information for monitoring and dose modification recommendations for digoxin concentration increases of <50%. cefamandole will increase the level or effect of digoxin by altering intestinal flora. Inotropy and automaticity are subsequently increased while conduction velocity is reduced. Applies only to oral form of both agents. Use Caution/Monitor. Avoid or Use Alternate Drug. Use Caution/Monitor. Use Caution/Monitor. If the drug must be administered by the intramuscular route, it should be injected deep into the muscle followed by massage. quinidine will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Potential for increased toxicity. Comment: Spironolactone may cause false elevation of digoxin assay. lornoxicam and digoxin both increase serum potassium. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Monitor Closely (1)streptomycin will increase the level or effect of digoxin by altering intestinal flora. Effect of interaction is not clear, use caution. Monitor heart rate in patients taking ivabradine with other negative chronotropes. Modify Therapy/Monitor Closely. The nurse suspects the patient may have toxic levels of digoxin in the bloodstream when what is assessed? Use Caution/Monitor. Applies only to oral form of both agents. carmustine decreases levels of digoxin by inhibition of GI absorption. When changing from parenteral to oral dose forms, dose adjustments may be necessary because of pharmacokinetic variations in percentage of digoxin absorbed: 100 mcg (0.1 mg) digoxin injection = 125 mcg (0.125 mg) tablet or 125 mcg (0.125 mg) of elixir. Doses may be increased every 2 weeks according to clinical response, serum drug levels, and toxicity. cytarabine decreases levels of digoxin by inhibition of GI absorption. Use Caution/Monitor. Monitor Closely (1)flurbiprofen and digoxin both increase serum potassium. Use Caution/Monitor. Use Caution/Monitor. Use Caution/Monitor. enalapril increases levels of digoxin by unspecified interaction mechanism. Nifedipine may decrease digoxin clearance, increasing plasma concentrations and the risk of toxicity. Hypokalemia increases digoxin effects. The patient taking digoxin (Lanoxin) has developed an infection. Plasma concentrations and pharmacologic effects of digoxin may be increased by ritonavir. celiprolol and digoxin both increase serum potassium. . Avoid or Use Alternate Drug. Manufactured by Baxter Healthcare Corporation Deerfield, IL 60015 USA For Product Inquiry 1 800 ANA DRUG (1-800-262-3784). Serious - Use Alternative (1)sotorasib will decrease the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Monitor Closely (1)etodolac and digoxin both increase serum potassium. Use Caution/Monitor. Monitor for adverse reactions if coadministered with P-gp substrates where minimal concentration changes may lead to serious or life-threatening toxicities. digoxin will increase the level or effect of trimethoprim by basic (cationic) drug competition for renal tubular clearance. Pedi: Neonates may have falsely elevated serum digoxin concentrations due to a naturally occurring substance chemically similar to digoxin. Use Caution/Monitor. Usual Adult Dose of Digoxin for Congestive Heart Failure: . IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. Avoid or Use Alternate Drug. potassium chloride and digoxin both increase serum potassium. Use Caution/Monitor. Monitor Closely (1)tigecycline will increase the level or effect of digoxin by altering intestinal flora. nitrofurantoin will increase the level or effect of digoxin by altering intestinal flora. Can increase risk of bradycardia. abrocitinib will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Monitor Closely (1)meropenem/vaborbactam will increase the level or effect of digoxin by altering intestinal flora. Use Caution/Monitor.Serious - Use Alternative (1)digoxin, betaxolol. Monitor for adverse reactions if coadministered with P-gp substrates where minimal concentration changes may lead to serious or life-threatening toxicities. Want to regain access to Davis's Drug Guide? Applies only to oral form of both agents. Minor/Significance Unknown. If coadministered, consider reducing digoxin dose. Applies only to oral form of both agents. Applies only to oral form of both agents. Minor/Significance Unknown. sotalol and digoxin both increase serum potassium. The following principles should be viewed as a general guide to the use of digoxin for its inotropic or electrophysiologic effects, which must be modified according to . neratinib increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. 1.25-2.5. Use Caution/Monitor. Use Caution/Monitor. fosinopril increases levels of digoxin by unspecified interaction mechanism. Use Caution/Monitor. Monitor for increased effects of digoxin. Monitor for increased effects of digoxin.ritonavir increases levels of digoxin by decreasing renal clearance. PO(Infantsfull term): Digitalizing dose2535 mcg/kg given as 50% of the dose initially and one quarter of the initial dose in each of 2 subsequent doses at 612 hr intervals. Intramuscular injection of digoxin is extremely painful and offers no advantages unless other routes of administration are contraindicated. Minor/Significance Unknown. Applies only to oral form of both agents. Monitor Closely (1)ticagrelor increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Avoid or Use Alternate Drug. Avoid or Use Alternate Drug. Monitor ECG during IV administration and 6 hr after each dose. Before administering initial loading dose, determine whether patient has taken any digoxin in the preceding 23 wk. oxytetracycline will increase the level or effect of digoxin by altering intestinal flora. Intramuscular injection of digoxin is extremely painful and offers no advantage unless other routes of administration are contraindicated. Enhanced bradycardia. Use Caution/Monitor. Monitor Closely (1)anticholinergic/sedative combos increases levels of digoxin by unspecified interaction mechanism. Applies only to oral form of both agents. Monitor Closely (1)dulaglutide, digoxin. Minor (1)exenatide injectable solution decreases levels of digoxin by unspecified interaction mechanism. WHO World Health Organization. digoxin increases and epinephrine racemic decreases serum potassium. Monitor Closely (1)diclofenac and digoxin both increase serum potassium. Closely monitor for signs and symptoms of increased exposure and consider adjusting the dose of these substrates. Minor/Significance Unknown. nirmatrelvir/ritonavir will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Monitor Closely (1)sodium picosulfate/magnesium oxide/anhydrous citric acid decreases levels of digoxin by cation binding in GI tract. Use Caution/Monitor. Monitor Closely (1)ibuprofen IV and digoxin both increase serum potassium. The IV dose is 75% of the oral dose. tacrolimus will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. stiripentol will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Monitor patient for signs of reduction in pharmacologic effect of digoxin and increase digoxin dose if necessary. To view formulary information first create a list of plans. Use Caution/Monitor. BRAND NAME: divided doses over 24-48h increasing the force Mental filbrillation . Applies only to oral form of both agents. Use Caution/Monitor. Use Caution/Monitor.chlorthalidone increases effects of digoxin by pharmacodynamic synergism. Notify health care professional if bradycardia or new arrhythmias occur. Vallerand, A. H., Sanoski, C. A., & Quiring, C. (2023). etravirine increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Applies only to oral form of both agents. Applies only to oral form of both agents. Digoxin capsules and digitoxin do not appear to be affected. Use Caution/Monitor. esomeprazole will increase the level or effect of digoxin by increasing gastric pH. The trusted provider of medical information since 1899. 2. Monitor Closely (1)vancomycin will increase the level or effect of digoxin by altering intestinal flora. mineral oil decreases levels of digoxin by inhibition of GI absorption. Hypokalemia increases digoxin effects. Potential for increased toxicity. Use Caution/Monitor. ibuprofen IV and digoxin both increase serum potassium. Measure serum digoxin concentrations before initiating glecaprevir/pibrentasvir. Monitor Closely (1)ketorolac and digoxin both increase serum potassium. A digitalizing dose is now used infrequently. Monitor Closely (1)imidapril increases levels of digoxin by unspecified interaction mechanism. Avoid or Use Alternate Drug. Use Caution/Monitor. Instruct patient to keep digoxin tablets in their original container and not to mix in pill boxes with other medications; may look similar to and may be mistaken for other medications. Please confirm that you would like to log out of Medscape. Monitor Closely (1)cefadroxil will increase the level or effect of digoxin by altering intestinal flora. Use Caution/Monitor. Use Caution/Monitor. Use Caution/Monitor. Modify Therapy/Monitor Closely. Modify Therapy/Monitor Closely. Either increases levels of the other by unspecified interaction mechanism. Use Caution/Monitor. pindolol and digoxin both increase serum potassium. Use Caution/Monitor. Use Caution/Monitor. It is used most often when treating arrhythmias or acute heart failure. A triage nurse in the emergency department is assessing a 78-year-old man. Use Caution/Monitor.torsemide increases effects of digoxin by pharmacodynamic synergism. This site complies with the HONcode standard for trust- worthy health information: verify here. moxifloxacin will increase the level or effect of digoxin by altering intestinal flora. acarbose will decrease the level or effect of digoxin by unspecified interaction mechanism. Use Caution/Monitor. Increases the force of myocardial contraction. Because of altered digoxin distribution and elimination, projected peak body stores for patients with renal insufficiency should be conservative (i.e., 6 to 10 mcg/kg). What common action do both cardiac glycosides and phosphodiesterase inhibitors have in common related to therapeutic action? doxorubicin liposomal decreases levels of digoxin by inhibition of GI absorption. Use Caution/Monitor. Applies only to oral form of both agents. Use Caution/Monitor. Consider dose reduction of sensitive P-gp substrates. Use Caution/Monitor. Effect of interaction is not clear, use caution. Neratinib inhibits P-gp transport. Calculate the intravenous dose for a 5-year-old child weighing 40 lb if the oral dose is determined to be 10 mcg/kg. Monitor Closely (1)clarithromycin will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Note: Your username may be different from the email address used to register your account. Use Caution/Monitor. Use Caution/Monitor. Maintenance dose510 mcg/kg given daily in 2 divided doses. The remaining one-fourth loading dose given after an additional 8 to 12 hours IV or PO 4. Avoid or Use Alternate Drug. Rarely,there are patients who are unable to tolerate digoxin at serum concentrations below 0.8 ng/mL. FDA Food and Drug Administration. Minor (1)melphalan will decrease the level or effect of digoxin by Other (see comment). Digoxin. Enhanced bradycardia. Concomitant disease states, concurrent medications, or other factors likely to alter the pharmacokinetic or pharmacodynamic profile of digoxin. Minor/Significance Unknown. Use Caution/Monitor. Use Caution/Monitor. Effect of interaction is not clear, use caution. What is the nurse's priority intervention? Modify Therapy/Monitor Closely. Use Caution/Monitor. Use Caution/Monitor. trazodone will decrease the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Calculate the intravenous dose for a 5-year-old child weighing 40 lb if the oral dose is determined to be 10 mcg/kg 15. Serious - Use Alternative (1)ibuprofen/famotidine will increase the level or effect of digoxin by increasing gastric pH. . Monitor Closely (1)moxifloxacin will increase the level or effect of digoxin by altering intestinal flora. Minor/Significance Unknown.cimetidine will increase the level or effect of digoxin by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor. Applies only to oral form of both agents. Monitor Closely (1)doxorubicin liposomal decreases levels of digoxin by inhibition of GI absorption. Use Caution/Monitor. dopamine increases toxicity of digoxin by pharmacodynamic synergism. If coadministration unavoidable, separate administration by at least 6 hr before or after administration of P-gp substrates with narrow therapeutic index. Comment: Dulaglutide slows gastric emptying and may impact absorption of concomitantly administered oral medications; be particularly cautious when coadministered with drugs that have a narrow therapeutic index. The patients age. Effect of interaction is not clear, use caution. Metoclopramide may decrease the absorption of digoxin. sevelamer decreases levels of digoxin by increasing elimination. Use Caution/Monitor. liraglutide decreases levels of digoxin by unspecified interaction mechanism. propantheline will increase the level or effect of digoxin by unspecified interaction mechanism. Measure serum digoxin concentrations before initiating concomitant drugs; continue monitoring and reduce digoxin dose as necessary. Monitor digoxin levels. Potential for increased toxicity. This drug is available at the lowest co-pay. posaconazole increases levels of digoxin by decreasing metabolism. Applies only to oral form of both agents. Use Caution/Monitor.Serious - Use Alternative (1)digoxin, nebivolol. In. If pt has renal insufficiency give 6 to 10 mcg/kg IBW. Storage Store at 20-25C (68-77F), excursions permitted to 15-30C (59-86F) [see USP Controlled Room Temperature]. Use Caution/Monitor. vandetanib increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Monitor Closely (1)lapatinib will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Monitor Closely (1)cannabidiol will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Use Caution/Monitor. Avoid or Use Alternate Drug. Use Caution/Monitor. Use Caution/Monitor. Monitor Closely (3)spironolactone, digoxin. Ticagrelor inhibits P-glycoprotein transporter. Monitor Closely (1)aspirin rectal and digoxin both increase serum potassium. cefadroxil will increase the level or effect of digoxin by altering intestinal flora. Comment: rhPTH causes transient increase in calcium and therefore, concomitant use with cardiac glycosides may predispose patients to digitalis toxicity if hypercalcemia develops. nafcillin will increase the level or effect of digoxin by altering intestinal flora. calcium carbonate will increase the level or effect of digoxin by increasing gastric pH. Avoid or Use Alternate Drug. Modify Therapy/Monitor Closely. Minor (1)digoxin and noni juice both increase serum potassium. Applies only to oral form of both agents. A: Generally acceptable. Avoid or Use Alternate Drug. Monitor Closely (1)neratinib increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Applies only to oral form of both agents. In vitro data suggest venetoclax may inhibit P-gp substrates at therapeutic dose levels in the gut. Use Caution/Monitor. Comment: Prolonged use of PPIs may cause hypomagnesemia and increase risk for digoxin toxicity.Serious - Use Alternative (1)pantoprazole will increase the level or effect of digoxin by increasing gastric pH. Hypokalemia increases digoxin effects. tucatinib will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Slow infusion of Digoxin Injection is preferable to bolus administration. Applies only to oral form of both agents. parecoxib and digoxin both increase serum potassium. Nursing Central combines Daviss Drug Guide with a medical dictionary, disease manual, lab guide, and useful tools. Potential for increased toxicity. * CAPITALS indicate life-threatening.Underline indicate most frequent. In selecting a dose of digoxin, the following factors must be considered: 1. Monitor Closely (1)levoketoconazole will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor Closely (2)sulfamethoxazole will increase the level or effect of digoxin by altering intestinal flora. ponatinib increases levels of digoxin by P-glycoprotein (MDR1) efflux transporter. Toxicity characterized by gastrointestinal and neuropsychiatric symptoms, and cardiac arrhythmias may result. Use Caution/Monitor. ), Table below provides average daily maintenance dose requirements of Digoxin Injection for patients with heart failure based upon lean body weight and renal function: Usual Daily Maintenance Dose Requirements (mcg) of Digoxin Injection for Estimated Peak Body Stores of 10 mcg/kg*, * Daily maintenance doses have been rounded to the nearest 25-mcg increment. Avoid or Use Alternate Drug. Digoxin is used to treat heart failure, usually along with other medications. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Measure serum digoxin concentrations before initiating concomitant drugs; continue monitoring and reduce digoxin dose as necessary. Applies only to oral form of both agents. ciprofloxacin will increase the level or effect of digoxin by altering intestinal flora. Avoid or Use Alternate Drug. tolvaptan will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. The nurse expects the patient's heart failure (HF) is caused by what diagnosis that is responsible for 95% of the cases diagnosed? Use Caution/Monitor. Use Caution/Monitor. Enhanced bradycardia. Minor (1)oxybutynin transdermal increases levels of digoxin by unspecified interaction mechanism. Oral: 1-2hours/ 2-8 hours. Use Caution/Monitor. Monitor Closely (2)cyclopenthiazide increases effects of digoxin by pharmacodynamic synergism. Amiodarone increases PO digoxin serum concentrations by ~70% and IV digoxin by ~17%; measure digoxin levels before initiating amiodarone and reduce PO digoxin dose by 30-50%; decrease IV digoxin dose by 15-30%. Use Caution/Monitor.betaxolol increases effects of digoxin by pharmacodynamic synergism. Minor/Significance Unknown. Use Caution/Monitor. Avoid or Use Alternate Drug. Use Caution/Monitor. Modify Therapy/Monitor Closely. salicylates (non-asa) and digoxin both increase serum potassium. digoxin will increase the level or effect of procainamide by basic (cationic) drug competition for renal tubular clearance. Both digoxin and hypoMg inhibit the Na-K-pump resulting in decreased . clindamycin will increase the level or effect of digoxin by altering intestinal flora. Use Caution/Monitor. amiloride and digoxin both increase serum potassium. Use Caution/Monitor. Monitor Closely (1)dopamine increases toxicity of digoxin by pharmacodynamic synergism. Digoxin is excreted by the kidney. Siberian ginseng increases levels of digoxin by unknown mechanism. sulfadiazine will increase the level or effect of digoxin by altering intestinal flora. Infants and Children See the full prescribing information for pediatric digoxin injection (not available from Baxter Healthcare) for specific recommendations. Applies only to oral form of both agents. Other (see comment). Effect of interaction is not clear, use caution. Bremelanotide may slow gastric emptying and potentially reduces the rate and extent of absorption of concomitantly administered oral medications. shepherd's purse, digoxin. Use Caution/Monitor. commonly, these are "non-preferred" brand drugs. prescription products. Use Caution/Monitor. Use Caution/Monitor. Toxicity characterized by gastrointestinal and neuropsychiatric symptoms, and cardiac arrhythmias may result.digoxin will increase the level or effect of verapamil by basic (cationic) drug competition for renal tubular clearance. Applies only to oral form of both agents. Use Caution/Monitor. Emphasize the importance of routine follow-up exams to determine effectiveness and to monitor for toxicity. Therapeutic drug monitoring and dose reduction of P-gp substrates should be considered when given orally and concurrently with cannabidiol. Measure serum digoxin concentrations before initiating nirmatrelvir/ritonavir.
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