Digoxin

Pronunciation: di-JOX-in.

Generic name
digoxin
Drug class
Cardiac glycoside
Form
Tablet (commonly 62.5 microgram, 125 microgram, 250 microgram) or oral solution
Route
Oral (tablet or oral solution); intravenous under hospital supervision
Legal status
Prescription-only

Availability and supply rules vary by country

Trade names by country: United States · United Kingdom · Canada · Australia · New Zealand

Australia: Lanoxin / Lanoxin PG (5) · Full directory

What digoxin is and how it works

Digoxin is a prescription-only heart medicine (a cardiac glycoside) used to help the heart pump more effectively in heart failure and to help control a fast heart rate in atrial fibrillation, an irregular heart rhythm. (1) (2)

Digoxin has a narrow safety margin -- the difference between a dose that helps and a dose that causes toxicity is small. Take digoxin exactly as your prescriber directs, attend all blood test and monitoring appointments, and contact your prescriber promptly, or seek emergency care, if you notice new nausea, vomiting, confusion, visual changes, or an irregular or unusually slow or fast heartbeat.

Mechanism of action: how digoxin works

Digoxin is a cardiac glycoside that inhibits the sodium-potassium (Na+/K+) ATPase pump in myocardial cells, increasing intracellular calcium availability. This produces a positive inotropic effect (stronger contraction), a negative chronotropic effect (slower heart rate), and reduced conduction velocity through the AV node, partly via increased vagal tone. (1) (2) (3)

What digoxin is used for

Heart failure

Used to help the heart pump more effectively in mild to moderate heart failure, improving symptoms and exercise capacity, usually alongside other heart failure medicines such as a diuretic and an ACE inhibitor. (1) (3)

Atrial fibrillation (irregular heart rhythm)

Used to help control the heart rate in chronic atrial fibrillation, an irregular and often fast heart rhythm arising in the upper chambers of the heart. (1) (2)

Before taking digoxin

Do not take / not appropriate for

  • Do not take digoxin if you have ventricular fibrillation (a life-threatening chaotic heart rhythm) or certain other dangerous heart rhythm conditions your prescriber will have already checked for. (all countries) (1) (2)
  • Do not take digoxin if you have had a serious allergic reaction to it or to another digitalis medicine. (all countries) (1) (3)
  • Digoxin is generally avoided in certain irregular heart rhythms linked to an extra electrical pathway in the heart (Wolff-Parkinson-White syndrome) and in a thickened-heart-muscle condition called hypertrophic obstructive cardiomyopathy, unless your prescriber has a specific reason and monitors you closely. (United Kingdom) (2)

Tell your clinician about

  • Any kidney problems -- digoxin is cleared by the kidneys and needs careful dose adjustment.
  • Low potassium, low magnesium, or high calcium levels, or any condition or medicine (such as certain water tablets) that could cause these.
  • Any history of an irregular heartbeat, heart block, or a pacemaker.
  • Thyroid problems, either underactive or overactive.
  • All other medicines you take, especially amiodarone, verapamil, diltiazem, quinidine, certain antibiotics (such as clarithromycin, erythromycin, or gentamicin), spironolactone, or any other heart or water-tablet medicines.
  • Pregnancy, plans for pregnancy, or breastfeeding.
  • Any planned procedure involving electrical shock to the heart (cardioversion), so this can be timed and managed safely.
(1) (2) (3)

How to take digoxin

  • Take digoxin exactly as your prescriber directs, at the same time each day.
  • Attend all blood tests your prescriber arranges, including checks of your digoxin level, kidney function, and electrolytes (especially potassium) -- these are essential, not optional, because of digoxin's narrow safety margin.
  • Do not change your dose, stop taking digoxin, or take an extra dose to make up for a missed one without your prescriber's guidance.
  • If you are switched between different digoxin products (for example, from tablets to a liquid or injection), your prescriber will adjust the dose, since these forms are not interchangeable at the same dose.
(1) (2)

Procedures and treatment changes

Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (1) (2) (3) (4) (5) (6)

Missed dose

If you miss a dose, contact your prescriber or pharmacist for specific advice rather than deciding on your own, since the right action depends on your individual dose and how late you are taking it. Never take a double dose to make up for a missed one.

Overdose

Digoxin overdose or toxicity is a medical emergency. Seek emergency medical help immediately, or contact your local poison control service, if you or someone else may have taken too much digoxin, or if you notice severe nausea and vomiting, confusion, visual disturbances, or a very slow, very fast, or irregular heartbeat. (1) (2)

Side effects

Side effects and their urgency vary; report severe, persistent, or concerning symptoms.

Nausea, vomiting, diarrhoea, or loss of appetite.

What to notice: Nausea, vomiting, diarrhoea, or loss of appetite.

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1) (2)

Dizziness or headache.

What to notice: Dizziness or headache.

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (2)

Skin rash.

What to notice: Skin rash.

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (2)

Changes in heart rhythm detected on an ECG, such as a slow heart rate.

What to notice: Changes in heart rhythm detected on an ECG, such as a slow heart rate.

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (2)

Serious warnings

Digoxin toxicity (a genuine medical emergency) — emergency

Symptoms: Nausea, vomiting, loss of appetite, confusion, visual disturbances (blurred vision, seeing halos, or a distinctive yellow-green tint to vision), and dangerous heart rhythm changes such as a very slow, very fast, or irregular heartbeat.

Action: Seek emergency medical care immediately if you notice these symptoms, especially any change in your heartbeat or visual disturbances. Do not wait to see if symptoms pass. Tell emergency responders that you take digoxin. (1) (2) (3)

Low potassium, low magnesium, or high calcium levels, which significantly increase toxicity risk — high caution

Symptoms: Often no specific symptoms of the electrolyte change itself, but these conditions make digoxin toxicity more likely to occur, even at blood levels that are otherwise in the usual range. Hypokalaemia (low potassium) is considered the single most significant risk factor.

Action: Attend all blood tests your prescriber arranges to check your potassium, magnesium, and calcium levels, particularly if you take water tablets (diuretics), have kidney problems, or have had vomiting or diarrhoea. Contact your prescriber promptly if you are unable to keep up with fluids or have prolonged vomiting or diarrhoea. (1) (2) (3)

Reduced kidney function increasing toxicity risk — high caution

Symptoms: No specific symptoms, but reduced kidney function slows how quickly digoxin is cleared from the body, so it can build up to toxic levels over time.

Action: Your prescriber will check your kidney function periodically and adjust your dose accordingly, especially if you are older or have known kidney disease. Tell your prescriber about any new kidney problems or dehydration. (1) (2) (3)

Interactions with certain medicines that raise digoxin levels — high caution

Symptoms: No specific symptoms on their own, but starting, stopping, or changing the dose of an interacting medicine can push your digoxin level into the toxic range.

Action: Make sure every prescriber and pharmacist you see knows you take digoxin. Confirmed interactions that raise digoxin levels include amiodarone, verapamil (and related calcium-channel blockers such as diltiazem), and quinidine, along with certain antibiotics (clarithromycin, erythromycin, gentamicin), itraconazole, spironolactone, propafenone, dronedarone, and some other medicines -- your prescriber may check your digoxin level and adjust your dose more closely whenever one of these is started or stopped. (1) (2)

Interactions

  • Amiodarone can significantly raise digoxin levels in the blood -- your prescriber will typically reduce your digoxin dose and monitor you more closely if amiodarone is started. (1) (2)
  • Verapamil, and related calcium-channel blockers such as diltiazem, can raise digoxin levels and also slow the heart rate further. (1) (2)
  • Quinidine can significantly raise digoxin levels in the blood. (1) (2)
  • Certain antibiotics, including clarithromycin, erythromycin, and gentamicin, can raise digoxin levels. (1) (2)
  • Spironolactone, itraconazole, propafenone, and dronedarone can also raise digoxin levels. (2)
  • Water tablets (diuretics such as furosemide or thiazide-type diuretics), corticosteroids, and some laxatives can lower your potassium level, which indirectly increases digoxin toxicity risk. (1) (3)
  • Certain medicines, including rifampicin, some anti-seizure medicines (such as phenytoin), and cholestyramine, can lower digoxin levels and reduce how well it works. (1)
  • Beta-blocker heart medicines can add to digoxin's slowing effect on the heart's electrical conduction. (2)

Pregnancy, breastfeeding, kidney/liver function, age

Pregnancy

Digoxin is not considered contraindicated in pregnancy, and no clear pattern of birth defects has been reported in the decades of clinical experience reviewed. Dosing needs may become less predictable during pregnancy, and your prescriber will monitor your digoxin level closely. Digoxin crosses the placenta, and newborns are monitored for signs of toxicity after birth. (1) (2) (3) (4) (5) (6)

Breastfeeding

Digoxin passes into breast milk, but the amount a breastfeeding infant receives is estimated to be far below a typical infant dose. Discuss with your prescriber, who may still suggest some monitoring depending on your individual situation. (1) (2) (3) (4) (5) (6)

Children

Used in children, including newborns, with individualised dosing based on age, weight, and kidney function -- premature and very young infants are particularly sensitive to digoxin and need especially careful, individualised dosing. (1) (2) (3) (4) (5) (6)

Elderly

Older adults often need a lower dose, since kidney function and muscle mass (which affects how digoxin is distributed in the body) commonly decline with age, increasing toxicity risk at doses that might be standard in a younger adult. (1) (2) (3) (4) (5) (6)

Hepatic_impairment

No specific dose adjustment is described in the sources reviewed for this dossier; digoxin is mainly cleared by the kidneys rather than the liver. (1) (2) (3) (4) (5) (6)

Renal_impairment

People with reduced kidney function need a lower dose and closer monitoring, since digoxin is mainly cleared from the body by the kidneys and can build up to toxic levels if this is not accounted for. (1) (2) (3) (4) (5) (6)

Source_ids

US-DAILYMED-DIGOXIN-2026,UK-EMC-DIGOXIN-2026,CA-HC-LANOXIN-2016 (1) (2) (3) (4) (5) (6)

Monitoring

Before starting

  • Baseline kidney function and electrolytes (especially potassium, magnesium, and calcium)
  • Baseline ECG where relevant
  • Review of other medicines for interactions

During treatment

  • Periodic blood tests to check your digoxin level, usually timed at least 6 hours after a dose for an accurate reading.
  • Periodic kidney function and electrolyte checks, especially potassium, magnesium, and calcium.
  • ECG monitoring where relevant.
  • Watching closely for any symptoms of toxicity, especially after starting a new medicine, becoming unwell, or being unable to keep up with fluids.
(1) (2) (3)

Storage

Store at room temperature (about 15-25C / 59-77F), in a dry place, protected from light. Keep out of reach of children -- digoxin can be dangerous, even in small amounts, if taken accidentally by a child.

Study the drug class: Cardiac glycosides

Professional information

Clinician-facing context only, sourced from current US FDA, UK SmPC, and Health Canada content reviewed for this dossier; verify against the current full label before prescribing.

United States

Indication: Mild to moderate heart failure; ventricular rate control in chronic atrial fibrillation

Dose summary: Individualised based on age, lean body weight, kidney function, and concomitant drugs. Loading doses (commonly cited around 10-15 mcg/kg in adults) followed by maintenance dosing (commonly cited around 3.4-5.1 mcg/kg/day in adults with normal renal function). Therapeutic serum range commonly cited as roughly 0.5-2 ng/mL; toxicity more common above 2 ng/mL. Blood level drawn at least 6 hours post-dose.

Renal context: Dosage reduction required with impaired renal function; specific maintenance dose tables provided based on creatinine clearance and lean body weight. (1)

United Kingdom

Indication: Chronic heart failure with systolic dysfunction; atrial fibrillation/flutter

Dose summary: Rapid loading 750-1500 micrograms as a single or divided dose, or slow loading 250-750 micrograms daily for one week, followed by maintenance dosing calculated from a formula incorporating renal function (creatinine clearance). Therapeutic range cited as 0.5-1.0 ng/mL; toxicity more common above 2 ng/mL.

Renal context: Reduce both initial and maintenance doses in renal impairment; elderly patients also need reduced doses. (2)

Mechanism of action

Hepatic guidance

No specific hepatic dose adjustment is described in the sources reviewed; digoxin is predominantly renally eliminated.

Overdose note

Toxicity management is guided by the treating clinician and may include withholding further doses, correcting electrolyte abnormalities (particularly potassium), continuous cardiac monitoring, and, in severe cases, digoxin-specific antibody fragments (digoxin immune Fab) as an antidote; intravenous calcium should generally be avoided in digitalised patients due to arrhythmia risk. (1) (2) (3)

Frequently asked questions

Is digoxin (Lanoxin) available in the US, UK, Europe, Canada, Australia, and New Zealand?

Yes, digoxin is an established, widely available medicine approved in all of these regions, originally and still often marketed as Lanoxin. (1) (2) (4) (3) (5) (6)

What are the signs of digoxin toxicity, and what should I do?

Signs include nausea, vomiting, loss of appetite, confusion, visual disturbances (such as blurred vision or a yellow-green tint to your vision), and changes in your heartbeat, such as it feeling unusually slow, fast, or irregular. Digoxin toxicity is a genuine medical emergency -- seek emergency medical help immediately if you notice these symptoms, and tell responders that you take digoxin. (1) (2)

Why do I need regular blood tests while taking digoxin?

Digoxin has a narrow safety margin, meaning the gap between a helpful dose and a toxic one is small. Regular blood tests check your digoxin level as well as your kidney function and electrolytes (especially potassium, magnesium, and calcium), since problems with any of these can make toxicity more likely even without a dose change. These tests are a standard, essential part of digoxin treatment, not an optional extra. (1) (2)

Are there important medicines that can interact with digoxin?

Yes. Amiodarone, verapamil, and quinidine are well-established examples of medicines that can raise digoxin levels in the blood and increase toxicity risk, along with several others including certain antibiotics and spironolactone. Always tell every prescriber and pharmacist that you take digoxin before starting any new medicine. (1) (2)

What is the mechanism of action of digoxin?

Digoxin is a cardiac glycoside that inhibits the sodium-potassium (Na+/K+) ATPase pump in myocardial cells, increasing intracellular calcium availability. This produces a positive inotropic effect (stronger contraction), a negative chronotropic effect (slower heart rate), and reduced conduction velocity through the AV node, partly via increased vagal tone. (1) (2) (3)

What is the generic name of Digoxin?

The generic name is digoxin. (1) (2)

What class of drug is digoxin?

Digoxin is classed as: Cardiac glycoside. (1) (2)

References

  1. DIGOXIN tablet -- full prescribing informationU.S. Food and Drug Administration / DailyMed (NIH), full prescribing information, digoxin tablets · United States · accessed 2026-07-29 · source 1
  2. Digoxin 0.25 mg Tablets -- Summary of Product Characteristicselectronic medicines compendium (emc), United Kingdom -- Aspen Pharma Trading Limited · United Kingdom · accessed 2026-07-29 · source 2
  3. LANOXIN (Digoxin Tablets, C.S.D.) Product MonographHealth Canada product monograph, Pharmascience Inc. · Canada · accessed 2026-07-29 · source 3
  4. Lanoxin 250 microgram Tablets / Lanoxin PG 62.5 microgram Tablets (Digoxin) -- HPRA product informationHealth Products Regulatory Authority (HPRA), Ireland (EU member state regulator) · European Union · accessed 2026-07-29 · source 4
  5. LANOXIN (digoxin) tablets and injection -- ARTG registrationTherapeutic Goods Administration (TGA), Australia · Australia · accessed 2026-07-29 · source 5
  6. LANOXIN (digoxin) tablets, elixir, and injection -- New Zealand Data SheetMedsafe (New Zealand regulator) · New Zealand · accessed 2026-07-29 · source 6

Brand names by country

Single-ingredient digoxin names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.

Priority countries

United States

  • LANOXIN250 ug/mL, .125 mg, .0625 mg, .25 mg, 100 ug/mL · covis pharma us, inc

United Kingdom

  • Digoxin (generic) / Lanoxin (2)MHRA licensed emc smpc confirmed · 0.0625 mg, 0.125 mg, 0.25 mg, oral solution, injection · Aspen Pharma Trading Limited (and other licence holders)

Canada

  • TOLOXIN
  • PEDIATRIC DIGOXIN INJECTION C.S.D.
  • DIGOXIN INJECTION C.S.D.

Australia

  • Lanoxin / Lanoxin PG (5)TGA ARTG registered confirmed · 62.5 microgram, 250 microgram · Aspen Pharmacare Australia Pty Ltd

New Zealand

  • Lanoxin (6)Medsafe approved confirmed · 62.5 microgram, 250 microgram, 50 microgram/mL elixir · not specified in fetched source
View brands in additional countries.

European Union

Lanoxin / digoxin (generic, nationally authorised in member states) (4)