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Drug Profile

The information on this site is intended to supplement and enhance, not replace, the advice of a physician who is familiar with your medical history. Decisions about your health should always be made ONLY after detailed conversation with your doctor.

Generic drug name: digoxin (di JOX in)
Brand name(s): LANOXIN
GENERIC: available FAMILIES: Drugs for Abnormal Heart Rhythm, Heart Failure & Angina
Find the drug label by searching at DailyMed.

Pregnancy and Breast-feeding Warnings [top]

Pregnancy Warning

No data are available for digoxin as it was not tested in animal studies. Use during pregnancy only for clear medical reasons. Tell your doctor if you are pregnant or thinking of becoming pregnant before you take this drug.

Breast-feeding Warning

Digoxin is excreted in human milk with the concentration in the milk about the same as in the mother’s blood. Because of the potential for serious adverse effects in nursing infants, you should not take this drug while nursing.

Facts About This Drug [top]

Digoxin is approved by the Food and Drug Administration (FDA) for the treatment of mild-to-moderate heart failure. It often is used in combination with a thiazide diuretic (water pill) or a loop diuretic such as furosemide (LASIX) in more severe cases, as well as an angiotensin-converting enzyme (ACE) inhibitor and a beta blocker. The symptoms of heart failure include fatigue, difficulty breathing, swelling (especially in the legs and ankles) and rapid or “galloping” heartbeats.

Digoxin...

Digoxin is approved by the Food and Drug Administration (FDA) for the treatment of mild-to-moderate heart failure. It often is used in combination with a thiazide diuretic (water pill) or a loop diuretic such as furosemide (LASIX) in more severe cases, as well as an angiotensin-converting enzyme (ACE) inhibitor and a beta blocker. The symptoms of heart failure include fatigue, difficulty breathing, swelling (especially in the legs and ankles) and rapid or “galloping” heartbeats.

Digoxin also is approved to control the rate of beating of the large chambers of the heart (ventricles) in people with atrial fibrillation, the most common disorder of the heart's rhythm, or arrhythmia.[1] Atrial fibrillation can cause palpitations (feelings that the heart is skipping a beat, fluttering, or beating too hard or fast), shortness of breath, chest pain, dizziness and fatigue. However, in many patients, the condition causes no symptoms.

Before prescribing digoxin for heart failure, doctors usually first try administering a thiazide diuretic (or a loop diuretic in more severe cases), as well as an ACE inhibitor and a beta blocker. Patients should be prescribed digoxin only if these other medications do not control symptoms well enough. In general, a patient over 60 years of age should take a smaller daily dose than the usual 0.25 milligrams,[2] especially if the patient has impaired kidney function.

A substantial body of research has demonstrated that treatment with digoxin in atrial fibrillation patients is associated with an increased risk of death.[3],[4],[5],[6],[7],[8] Based on these findings and the other known adverse effects of digoxin, other drugs, such as beta blockers, should be tried first to control the heart rate in atrial fibrillation patients.

Adverse effects

Anyone taking digoxin is at risk of toxic effects (digitalis toxicity). While a patient is taking digoxin, their doctor should regularly check the levels of the drug in the blood. Both the patient and the doctor also should watch for the subtle symptoms of toxicity: fatigue, loss of appetite, nausea and vomiting, problems with vision, bad dreams, nervousness, drowsiness and hallucinations.[9] Other signs of toxicity are changes in heart rhythm, slow pulse and lethargy. Since there is a narrow range between a helpful and a harmful amount of digoxin in the body, patients should take the drug daily in the exact amount prescribed. If too much digoxin enters the body, the patient may experience the effects listed above. If there is too little digoxin, a patient may develop symptoms of heart failure or a rapid heart rate.

The abrupt onset of dementia has been associated with digoxin use. The dementia is reversible when digoxin use is stopped.[10]

Studies show ...

An article published in the Journal of Clinical Oncology in 2011 presented information from a Denmark study on the incidence of breast cancer in women using digoxin and in women using angina drugs. The study found that women using digoxin had an increased risk of breast cancer, and that risk normalized when digoxin was discontinued. However, the authors of the study stated the following in their conclusion:

Although the digoxin effect we observed was similar to that of postmenopausal estrogens, it was nevertheless small, and the importance of digoxin to the clinical management of heart disease may outweigh our inferences regarding increased risks of breast cancer.[11]

A study published in Pharmacoepidemiology and Drug Safety in 2014 showed that treatment with digoxin was associated with a higher risk of colorectal cancer.[12]

In 2021, PLOS One published results of an observational study showing that digoxin use was associated with an increased risk of death from all causes in patients with advanced chronic kidney disease.[13]

A retrospective observational study published in 2021 in Cancer Causes and Control found that digoxin use was associated with a modestly increased risk of pancreatic cancer.[14]

Misprescribing and conditions for ceasing digoxin treatment

Digoxin is often overprescribed for older adults.[15] One study of people using digoxin outside the hospital found that four out of 10 received no benefit from the drug.[16] Because of digoxin’s toxic effects, taking the drug without any benefit is both wasteful and dangerous. As many as one in five digoxin users develop signs of toxic effects,[17] and much of this could be prevented if the people who did not need digoxin were taken off the drug. Evidence shows that up to eight out of 10 long-term digoxin users can successfully stop using the drug, under close supervision by a doctor, with no harmful results.[18] This is partly due to digoxin being wrongly prescribed in the first place.

If you have used digoxin regularly for some time, ask your doctor if you might be able to try withdrawing from the drug. You are more likely to be able to stop taking digoxin if you meet the following conditions:

  1. You have used digoxin for a long time without your initial symptoms of heart failure coming back.
  2. You have a normal heart rhythm.
  3. You are not using digoxin to control an irregular heart rhythm.

There is no precise way to know in advance who can stop taking digoxin. People taking digoxin to correct an irregular heart rhythm should not attempt to stop taking the drug, but most other people will benefit from a trial of withdrawal under close supervision by a doctor.

Drug Interactions

Digoxin can interact with several dozen other drugs (see our November 2018 Worst Pills, Best Pills News article, “Potentially Dangerous Digoxin Drug Interactions,” for details). These interactions can result in either digoxin toxicity or decreased digoxin effectiveness, depending on the other drug being used concomitantly.

Before You Use This Drug [top]

Do not use if you have or have had:

  • toxic effects from other digitalis preparations
  • ventricular fibrillation
  • pregnancy or are breast-feeding

Tell your doctor if you have or have had:

  • allergies to drugs
  • decreased thyroid hormones
  • rheumatic fever
  • heart block
  • carotid sinus hypersensitivity
  • high or low blood potassium, magnesium, or calcium levels
  • insufficient oxygen supply to the heart
  • irregular or rapid heartbeat
  • kidney or liver problems
  • heart attack
  • severe lung disease
  • heart disease in which enlargement of the heart muscle decreases the heart’s ability to pump blood (IHSS)

Tell your doctor about any other drugs you take, including aspirin, herbs, vitamins, and other nonprescription products.

When You Use This Drug [top]

  • Learn to take your pulse, and get immediate medical help if your pulse slows to 60 beats per minute or less. Some people have suffered a slow heart rate and heart failure while using digoxin.
  • Do not stop taking this drug suddenly. Your doctor must give you a schedule to lower your dose gradually, to prevent serious changes in your heart function.
  • Wear a medical identification bracelet or carry a card saying that you take digoxin.
  • Eat a diet that is rich in potassium, adequate in magnesium, and low in salt and dietary fiber (see section on potassium supplementation).
  • Do not take other drugs without talking to your doctor first—especially nonprescription drugs for appetite control, asthma, colds, coughs, hay fever, or sinus problems.
  • If you plan to have any surgery, including dental, tell your doctor that you take this drug.

How to Use This Drug [top]

  • If you miss a dose, either take within 12 hours or wait until your next scheduled dose. Do not take double doses. If you miss two or more doses in a row, call your doctor.
  • Do not share your medication with others.
  • Take the drug at the same time(s) each day.
  • Crush tablets and mix with water, or swallow whole with water.
  • Measure the liquid form only with the specially marked dropper.
  • Store at room temperature with lid on tightly. Do not store in the bathroom. Do not expose to heat, moisture, or strong light. Keep out of reach of children.

Interactions with Other Drugs [top]

The following drugs, biologics (e.g., vaccines, therapeutic antibodies), or foods are listed in Evaluations of Drug Interactions 2003 as causing “highly clinically significant” or “clinically significant” interactions when used together with any of the drugs in this section. In some sections with multiple drugs, the interaction may have been reported for one but not all drugs in this section, but we include the interaction because the drugs in this section are similar to one another. We have also included potentially serious interactions listed in the drug’s FDA-approved professional package insert or in published medical journal articles. There may be other drugs, especially those in the families of drugs listed below, that also will react with this drug to cause severe adverse effects. Make sure to tell your doctor and pharmacist the drugs you are taking and tell them if you are taking any of these interacting drugs:

ACHROMYCIN, ADVIL, ALDACTONE, alprazolam, aluminum hydroxide, amiodarone, AMPHOJEL, ANECTINE, antacids, arbutamine hydrochloride, atorvastatin, AZULFIDINE, BIAXIN, CALAN SR, CALCIJECT, calcium chloride injection, CAPOTEN, captopril, cholestyramine, clarithromycin, CORDARONE, COVERA HS, CUPRIMINE, cyclophosphamide, cyclosporine, CYTOXAN, DELTASONE, DEPEN, diazepam, DILANTIN, diphenoxylate, DURAQUIN, EES, ERYTHROCIN, erythromycin, furosemide, GAVISCON, GLUCOVANCE, hydroxychloroquine, ibuprofen, INDOCIN, indomethacin, ISOPTIN SR, itraconazole, kaolin and pectin, KAO-SPEN, KAPECTOLIN, LASIX, LIPITOR, LOCHOLEST, LOMOTIL, magnesium hydroxide, magnesium trisilicate, MATULANE, metformin, METICORTEN, metoclopramide, MICARDIS, MINIPRESS, MOTRIN, neomycin, NEORAL, NEO-RX, ONCOVIN, PANMYCIN, paricalcitol, penicillamine, phenytoin, PHILLIPS’ MILK OF MAGNESIA, PLAQUENIL, potassium-depleting diuretics, prazosin, prednisone, PRO-BANTHINE, procarbazine, propafenone, propantheline, QUESTRAN, QUINAGLUTE DURA-TABS, QUINIDEX, quinidine, REGLAN, RYTHMOL, SANDIMMUNE, spironolactone, SPORANOX, succinylcholine, sulfasalazine, telmisartan, tetracycline, THYROID STRONG, tramadol, ULTRAM, VALIUM, VERELAN, verapamil, vincristine, XANAX, ZEMPLAR.

Adverse Effects [top]

Call your doctor immediately if you experience:

  • loss of appetite
  • nausea or vomiting
  • lower stomach pain
  • diarrhea
  • slow and/or irregular heartbeats
  • slow pulse
  • unusual tiredness or weakness
  • blurred vision or colored “halos”
  • depression or confusion
  • anxiety
  • drowsiness
  • headache
  • bad dreams, hallucinations, nervousness
  • skin rash or hives
  • fainting
  • dizziness

Periodic Tests[top]

Ask your doctor which of these tests should be done periodically while you are taking this drug:

  • blood pressure and pulse rate
  • heart function tests, such as electrocardiogram (ECG, EKG)
  • kidney function tests
  • liver function tests
  • blood levels of potassium, magnesium, and calcium
  • blood levels of digoxin

last reviewed June 30, 2021