Drug interactions
Digoxin + Furosemide
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Overview
Loop diuretic–induced hypokalemia and/or hypomagnesemia increases myocardial sensitivity to digoxin, raising risk of arrhythmias and toxicity; diuretic-induced AKI may also reduce digoxin clearance.
Mechanism of action
Pharmacodynamic: K+/Mg2+ depletion potentiates digoxin effects on cardiac conduction and automaticity. Pharmacokinetic: volume depletion/AKI can reduce renal clearance of digoxin.
Clinical management
Avoid and correct electrolyte abnormalities; maintain K+ >4 mEq/L and Mg2+ >2 mg/dL. Consider potassium supplementation or a K-sparing diuretic. Monitor K+, Mg2+, and serum creatinine at baseline, within 1 week of starting or changing furosemide dose, and periodically thereafter. Check digoxin concentration 3–7 days after significant diuretic changes and if toxicity suspected; adjust digoxin dose as needed. Educate on toxicity symptoms and obtain ECG if symptomatic.
Drug reference
References
- Digoxin: Drug Interactions (monograph) — Lexicomp
- Furosemide (Lasix) Prescribing Information – Warnings: electrolyte depletion and digitalis glycoside toxicity — FDA Label
- Digoxin: Clinical use and therapeutic monitoring — UpToDate
- Lanoxin (digoxin) Prescribing Information – Risk of toxicity with hypokalemia — FDA Label
Frequently asked questions
Can I take Digoxin with Furosemide?
The interaction is rated: Major. Loop diuretic–induced hypokalemia and/or hypomagnesemia increases myocardial sensitivity to digoxin, raising risk of arrhythmias and toxicity; diuretic-induced AKI may also reduce digoxin clearance.
How serious is the interaction between Digoxin and Furosemide?
The interaction is rated: Major. Evidence level: High.
How is the interaction between Digoxin and Furosemide managed?
Avoid and correct electrolyte abnormalities; maintain K+ >4 mEq/L and Mg2+ >2 mg/dL. Consider potassium supplementation or a K-sparing diuretic. Monitor K+, Mg2+, and serum creatinine at baseline, within 1 week of starting or changing furosemide dose, and periodically thereafter. Check digoxin concentration 3–7 days after significant diuretic changes and if toxicity suspected; adjust digoxin dose as needed. Educate on toxicity symptoms and obtain ECG if symptomatic.
Why do Digoxin and Furosemide interact?
Pharmacodynamic: K+/Mg2+ depletion potentiates digoxin effects on cardiac conduction and automaticity. Pharmacokinetic: volume depletion/AKI can reduce renal clearance of digoxin.
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