Digoxin and Khella: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Digoxin
Khella
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.
What happens
Reduced effectiveness of digoxin
Interaction Deep Dive
Visnadin has been identified as one of several active components of khella. This lactone has been shown to antagonize toxic effects of digitoxin in animals1. While this can be used for therapeutic advantage in cases of toxicity, it is reasonable to assume that visnadin will also affect the cardiac glycosides when used in the normal dosage range. The exact mechanism of antagonistic action of visnadin on cardiac glycosides is not yet known but may be related to competitive antagonism 1. Visnadin increases coronary perfusion and cardiac contractile force while only slightly increasing oxygen consumption by increasing myocardial glucose reserve 2. Visnadin, khellin, visnagan, samadin, and dihydrosamidin (all components of khella, Ammi visnaga) are potent coronary vasodilators 324. Visnadin and samidin are potent cAMP-phosphodiesterase inhibitors 4. Caution is advised if khella and digoxin are used concomitantly. Frequent monitoring of blood digoxin levels and symptomatology is recommended.
Why it happens (mechanism)
Increased coronary perfusion and cardiac contractile force, coronary vasodilation, cAMP-phosphodiesterase inhibition
Literature reports
1 report — tap to read
a) Digitoxin was administered to 10 mice by subcutaneous (SC) injection with escalating oral visnadin (khella) doses (0 to 450 milligrams/kilogram (mg/kg)). The LD50 of digitoxin was 14.4 +/- 0.48 mg/kg with no visnadin administered versus 24.4 +/- 0.78 mg/kg when coadministered with 300 mg/kg of visnadin. Digitoxin 2.5 mg/kg/day was administered SC for two days followed by 3.5 mg/kg/day until death occurred. One group of mice received digitoxin only, while the second group of 10 mice received the same digitoxin dose plus 400 mg/kg of visnadin. The control group survived for an average of 9.3 days versus the visnadin-treated group whose survival averaged 12.8 days. The mean lethal doses were 25 mg/kg and 35 mg/kg for control and visnadin-treated groups, respectively. When digitoxin 2.5 mg/kg/day was given SC alone and with 200 mg/kg oral visnadin, electrocardiograms showed that the addition of visnadin strongly reduced the digitoxin-induced bradycardia 1.
Common questions
Can I take Digoxin and Khella together?
Reduced effectiveness of digoxin Always confirm with your pharmacist or prescriber before making any change.
How serious is the Digoxin and Khella interaction?
It is rated moderate. Can be significant — usually manageable with monitoring.
How quickly could this interaction happen?
The documented onset is "rapid". Effects can appear quickly, often within about 24 hours of combining the drugs.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Digoxin or Khella 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 (4)
- Varonos DD, Voukydes PC, & Nikitopoulou: Digitoxin antagonism by visnadin. J Pharm Sci 1962; 51(10):1013-1014. DOI
- Eyraud H & Aurousseau M: Study of the action of visnadine on general and cardiac hemodynamics. Arzneim Forsch 1973; 23(2):201-207.
- Smith E, Hosansky N, Bywater WG, et al: Constitution of samidin, dihydrosamidin and visnadin. J Am Chem Soc 1957; 79:3534-3540.
- Thastrup O, Fjalland B, & Lemmich J: Coronary vasodilatory, spasmolytic and cAMP-phosphodiesterase inhibitory properties of dihydropyranocoumarins and dihydrofuranocoumarins. Acta Pharmacol Toxicol 1983; 52:246-253. PubMed
Keep reading about Digoxin
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