Drug interactions
Digoxin + Metolazone
Severity: Major
Digoxin and Metolazone: major interaction.
Last updated Sources: US FDA label
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.
Summary
Metolazone-induced hypokalemia and hypomagnesemia increase myocardial sensitivity to digoxin and raise the risk of digoxin toxicity and arrhythmias. This is a well-recognized concern with diuretics in heart failure.
What this interaction means in plain words
Digoxin and Metolazone can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Digoxin belongs to Cardiovascular; Metolazone belongs to Cardiovascular.
Why it happens
Diuretic-induced hypokalemia and hypomagnesemia enhance digoxin binding to Na+/K+-ATPase and increase arrhythmogenicity.
What to do
Monitor serum potassium and magnesium and keep potassium in the normal range. Check digoxin levels and watch for signs of toxicity.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Metolazone
Other interactions of Digoxin
- Digoxin + Lily of the valley Contraindicated
- Digoxin + Squill Contraindicated
- Adagrasib + Digoxin Major
- Amiodarone + Digoxin Major
- Amlodipine-hydrochlorothiazide-valsartan + Digoxin Major
- Amphotericin b deoxycholate + Digoxin Major
Frequently asked questions
Can I take Digoxin with Metolazone?
MediHelp rates the interaction as major. Digoxin and Metolazone can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Metolazone-induced hypokalemia and hypomagnesemia increase myocardial sensitivity to digoxin and raise the risk of digoxin toxicity and arrhythmias. This is a well-recognized concern with diuretics in heart failure.
How serious is the interaction between Digoxin and Metolazone?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor serum potassium and magnesium and keep potassium in the normal range. Check digoxin levels and watch for signs of toxicity.
What other medicines interact with Metolazone?
MediHelp also lists interactions of Metolazone with, for example, Amifostine, Amlodipine-hydrochlorothiazide-valsartan, Amlodipine-olmesartan-hydrochlorothiazide. The full list is on the Metolazone page.
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