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Digoxin toxicity — GPhC CRA MCQ

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HardCardiovascular TherapeuticsDigoxin toxicityGPhC CRA

A patient stable on digoxin develops nausea and bradycardia three days after starting clarithromycin. What interaction should the pharmacist suspect?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Raised digoxin exposure from inhibited transport and altered gut handling

Macrolides can increase digoxin exposure through P-glycoprotein inhibition and changes in intestinal flora. New nausea and bradycardia require urgent clinical assessment, ECG, renal/electrolyte review and a correctly timed digoxin level when useful.

Reference: BNF: digoxin: https://bnf.nice.org.uk/drugs/digoxin/