Atenolol and Digitoxin: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 15, 2026 · Source data updated Jul 11, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Atenolol
Digitoxin
No brand names on record
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
Both of these medicines slow your heart down. Atenolol is a beta-blocker, and digitoxin is a digitalis heart medicine. Each one slows the electrical signals in your heart and lowers your heart rate on its own. When you take them together, that effect can add up, and your heart rate may drop too low. This is called bradycardia.
Signs to watch for include feeling very tired, dizzy, lightheaded, or like your heart is beating slowly or skipping. The good news is that your care team can manage this by checking your heart rate and adjusting your doses if needed. Keep taking both as prescribed, and let your doctor or pharmacist know if you feel any of these symptoms.
Mechanism: Additive negative chronotropic and dromotropic effects. Both atenolol (beta-1 blockade) and digitoxin (enhanced vagal tone at the AV node) slow AV conduction and lower heart rate. Neither is a prodrug; this is a pharmacodynamic, not pharmacokinetic, interaction.
- Direction: Additive, increasing risk of bradycardia and possible digitalis toxicity.
- Evidence / severity: Probable; moderate. Onset unspecified.
- Monitoring: Heart rate and PR interval; assess for symptomatic bradycardia and signs of glycoside toxicity.
- Management: If severe bradycardia develops, the beta-blocker dose may be reduced or discontinued per the care team.
What happens
Increased risk of bradycardia and possible digitalis glycoside toxicity
Interaction Deep Dive
Because digitalis glycosides as well as beta-blockers reduce heart rate and slow conduction through the atrioventricular node, using them together may heighten the likelihood of bradycardia3412. When these agents are given at the same time, heart rate and the PR interval should be tracked34. Should severe bradycardia occur, the dose of metoprolol should be lowered or the drug stopped1.
Why it happens (mechanism)
Additive effects on AV node conduction
How to manage this interaction
Keep taking both medicines as prescribed unless your doctor tells you otherwise. This is a manageable combination when your team keeps an eye on things.
- Your care team will typically monitor your heart rate and PR interval (an ECG measurement) while you are on both drugs.
- If your heart rate drops too low, your beta-blocker dose may be reduced or stopped by your prescriber. Your doses can be adjusted and individualized to keep you safe.
- Tell your pharmacist or doctor promptly if you feel dizzy, unusually tired, faint, or notice a very slow or irregular pulse.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) In children, carvedilol raised serum digoxin levels, and a dose reduction may be required to prevent toxicity. Eight children treated with digoxin for ventricular failure resulting from complex congenital heart disease were monitored for any pharmacokinetic interactions both before and after carvedilol was added. The children were between 2 weeks and 7.8 years of age, and the daily carvedilol dose was titrated based on clinical response. Digoxin clearance was determined before and after a minimum of 4 days on an unchanged carvedilol dose. In one child, there were 2 instances of discontinuation, which produced a fall in the apparent clearance of digoxin followed by a rebound in clearance once the drug was withdrawn. The carvedilol dose ranged from 0.1 mg/kg/day to 1.02 mg/kg/day. GFR was not significantly altered before and after carvedilol administration. There was a mean 2-fold reduction in digoxin clearance (from 153.0 +/- 92.3 mL/min/1.73 m(2) to 80.6 +/- 23.9 mL/min/1.73 m(2), p=0.056), and the ratio of digoxin clearance to GFR fell from 1.8 +/- 0.60 to 1.00 +/- 0.24 (p=0.002). Multiple regression analysis incorporating age, initial ratio, and carvedilol dose confirmed the univariate analysis, with the initial ratio being the significant factor (p=0.05), while dose (p=0.78) and age (p=0.5) were not significant. The author concluded that the carvedilol-digoxin interaction is intensified in children, possibly due to greater expression of the P-glycoprotein pump 5.
Common questions
Can I take Atenolol and Digitoxin together?
Taking atenolol and digitoxin together can add up to slow your heart too much, so your care team will watch your heart rate and adjust doses if needed. Keep taking both as prescribed and report any dizziness or a very slow pulse. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Atenolol and Digitoxin interaction?
It is rated moderate. Can be significant — usually manageable with monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Atenolol and Digitoxin interaction managed?
Keep taking both medicines as prescribed unless your doctor tells you otherwise. This is a manageable combination when your team keeps an eye on things. Your care team will typically monitor your heart rate and PR interval (an ECG measurement) while you are on both drugs. If your heart rate drops too low, your beta-blocker dose may be reduced or stopped by your prescriber. Your doses can be adjust… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Atenolol or Digitoxin need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there anything you'd monitor while I'm on both?
References (5)
- Product Information: TOPROL-XL(R) oral extended-release tablets, metoprolol succinate oral extended-release tablets. Aralez Pharmaceuticals US Inc (per FDA), Parsippany, NJ, 2022. DailyMed
- Product Information: KAPSPARGO SPRINKLE(R) oral extended-release capsules, metoprolol succinate oral extended-release capsules. Sun Pharmaceutical Industries Inc (per DailyMed), Cranbury, NJ, 2020. DailyMed
- Product Information: Lopressor(R) oral tablets, metoprolol tartrate oral tablets. Validus Pharmaceuticals, LLC (per FDA), Parsippany, NJ, 2013. DailyMed
- Product Information: Lopressor(R) intravenous injection, metoprolol tartrate intravenous injection. Novartis Pharmaceuticals Corporation (per FDA), East Hanover, NJ, 2013. DailyMed
- Ratnapalan S, Griffiths K, Moldovan Costei A, et al: Digoxin-carvedilol interactions in children. J Pediatr 2003; 142:572-574. PubMed
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