Atenolol and Metildigoxin: 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
Metildigoxin
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.
Atenolol (a beta-blocker) and metildigoxin (a digitalis-type heart medicine) both slow down your heart and how signals travel through it. When you take them together, your heart rate can drop lower than either one would cause alone. Your body may also hold onto more of the digitalis effect, which can lead to signs like a very slow or irregular pulse, nausea, dizziness, or feeling unusually tired.
The good news is that this combination is used on purpose in many people, and your care team can manage it. They may check your heart rate and adjust doses as needed. Keep taking both as prescribed, and let your pharmacist or doctor know if you feel faint, very slow, or sick to your stomach.
Effect: Additive negative chronotropic and dromotropic effects at the AV node, increasing risk of bradycardia and potential digitalis glycoside toxicity.
Mechanism: Both agents depress AV nodal conduction and lower heart rate (pharmacodynamic, additive). Neither is a prodrug; direction is straightforward additive bradycardia.
- Severity/Evidence: Moderate; substantiation probable. Onset unspecified.
- Monitoring: Heart rate and PR interval; watch for digitalis toxicity signs (GI upset, visual changes, arrhythmia).
- Management: If severe bradycardia develops, reduce or discontinue the beta-blocker. Individualize dosing.
What happens
Increased risk of bradycardia and possible digitalis glycoside toxicity
Interaction Deep Dive
Digitalis glycosides as well as beta-blockers both reduce heart rate and slow conduction through the atrioventricular node, so using them together may raise the likelihood of bradycardia3412. When these two agents are given at the same time, heart rate and the PR interval should be monitored34. 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
This combination is often used intentionally, and your care team can manage it safely.
- Keep taking both exactly as prescribed unless told otherwise.
- Your team may monitor your heart rate and PR interval more closely, especially when starting or changing doses.
- Doses may need to be adjusted and individualized by your care team. If severe slowing of the heart develops, they may reduce or stop the beta-blocker.
- Tell your pharmacist or prescriber if you notice a very slow or irregular pulse, dizziness, fainting, nausea, or vision changes.
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 dose reduction may be necessary to prevent toxicity. Eight children receiving digoxin for ventricular failure secondary to complex congenital heart disease were monitored for 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 adjusted according to 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 when the drug was withdrawn. The carvedilol dose spanned from 0.1 mg/kg/day to 1.02 mg/kg/day. GFR showed no significant change before versus after carvedilol administration. There was an average 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 corroborated 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 and digoxin interaction is more pronounced in children, possibly owing to greater expression of the P-glycoprotein pump 5.
Common questions
Can I take Atenolol and Metildigoxin together?
Taking atenolol and metildigoxin together can add up to slow your heart too much, so your care team will watch your heart rate and can adjust doses; report a very slow pulse, dizziness, or nausea. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Atenolol and Metildigoxin 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 Metildigoxin interaction managed?
This combination is often used intentionally, and your care team can manage it safely. Keep taking both exactly as prescribed unless told otherwise. Your team may monitor your heart rate and PR interval more closely, especially when starting or changing doses. Doses may need to be adjusted and individualized by your care team. If severe slowing of the heart develops, they may reduce or stop the be… 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 Metildigoxin 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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